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Primary obturator-muscle pyomyositis in immunocompetent children

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

Primary pyomyositis in immunocompetent children in non-tropical regions (countries with temperate climates) is very uncommon. It is rarely found in the intrapelvic muscles, and even more rarely in the obturator muscles. We try to draw attention to the potential occurrence in these conditions.

Methods

Five new cases of primary obturator-muscle pyomyositis in immunocompetent children aged between 6 and 11 years in a temperate climate are presented. They present with symptoms as follows: fever, pain (thigh, abdominal, inguinal, and/or hip pain), and limp. Three of them had no hip movement limitation. All of them had tenderness in the perineum zone.

Results

Laboratory tests may reveal high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) counts, but depend on the length of diagnostic delay. The evolution time oscillated from 1 to 5 days. Fever and limp disappearance depends on the evolution time previous to the onset of the antibiotics administration. In 4 out of 5 patients, Staphylococcus aureus was present in the blood cultures. In all cases of obturator-muscle pyomyositis, diagnosis was confirmed using computed tomography (CT) scan (one) and/or magnetic resonance imaging (MRI) (four).

Conclusions

Obturator-muscle pyomyositis is aimed at emphasizing the diagnostic difficulties associated with the condition, due to its deep location and to the fact that the disease presents with multiple manifestations that may initially cause confusion, since they mimic other conditions occurring in the abdomen, hip (septic arthritis, osteomyelitis), spine, etc. The diagnosis is only confirmed using CT scan and/or MRI. In the five patients with antibiotics treatment, the condition resolves without sequelae, even at long-term follow-up.

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Authors and Affiliations

  1. Pediatric Trauma and Orthopaedic Section, Department of Orthopaedic Surgery and Trauma, Complejo Hospitalario de Navarra B, C/Irunlarrea, 4, 31008, Pamplona, Spain

    Serafín García-Mata & Angel Hidalgo-Ovejero

  2. Pediatric Radiologist, Complejo Hospitalario de Navarra B, C/Irunlarrea, 4, 31008, Pamplona, Spain

    Joaquín Esparza-Estaun

Authors
  1. Serafín García-Mata
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  2. Angel Hidalgo-Ovejero
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  3. Joaquín Esparza-Estaun
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Correspondence to Serafín García-Mata.

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García-Mata, S., Hidalgo-Ovejero, A. & Esparza-Estaun, J. Primary obturator-muscle pyomyositis in immunocompetent children. J Child Orthop 6, 205–215 (2012). https://doi.org/10.1007/s11832-012-0418-y

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  • DOI: https://doi.org/10.1007/s11832-012-0418-y

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