Pyomyositis

CORRESPONDENCE

Sir,

We read with interest the report in the January 2001 issue by Peckett et al1 entitled `Pyomyositis of the iliacus muscle in a child'. They stress the rarity of pyomyositis affecting children in temperate climates.

We recently reported two cases of childhood pyomyositis affecting the adductor muscles of the leg.2 The affected individuals were immunocompetent boys aged four and nine years who were native to and resident within the UK. Each presented early, unlike the patient of Peckett et al, with irritable hips. Both grew positive bacteriological blood cultures, both were diagnosed within five days of the onset of symptoms by MRI and in both the condition resolved with appropriate systemic antibiotics alone.

We were similarly interested by the article of Perkin, Warren and Ogilvie.3 They report a seven-year-old girl, presumed (although not explicitly stated) to be from the UK, with pyomyositis of the erector spinae, which was diagnosed by MRI. Again, she was successively managed with antibiotics alone.

We are encouraged by the reports of Peckett et al and Perkin et al. They support our endorsement of the use of MRI for early definitive diagnosis of suspected infection around the hip or pelvis. This view is shared by Macnicol in his recent review of musculoskeletal infection in childhood.4 It is possible that pyomyositis may be more common than is currently supposed. It may previously have been treated empirically with broad-spectrum antibiotics in the septic, but undiagnosed, child, when MRI was either not available or not considered to be appropriate. The advantage of MRI over other modalities lies in its ability to diagnose pyomyositis before formation of an abscess occurs.

1. Peckett WRC, Butler-Manuel A, Apthorp LA. Pyomyositis of the iliacus muscle in a child. J Bone Joint Surg [BrI 2001;83-13:103-5. 2. Thomas S, et al. J Paediatr Orthop B 2001;in press.

3. Perkin MR, Warren M, Ogilvie D. A child with pyrexia, flank pain and hip symptoms. J R Soc Med 2001;94:85-6.

4. Macnicol MF. Patterns of musculoskeletal infection in childhood. J Bone Joint Surg [Br] 2001;83-B:1-2.

S. THOMAS, MA, MRCS

G. TYTHERLEIGH-STRONG, FRCS Orth

R. DODDS, OBE, FRCS Orth

Royal Berkshire Hospital, Reading, UK.

Copyright British Editorial Society of Bone & Joint Surgery May 2001
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