Primary pyomyositis of the pelvis in children: a retrospective review of 8 cases.

[pyomyositis]

Primary pyomyositis of the pelvic musculature is a condition rarely seen in temperate climates , although its frequency has been increasing in the United States . The condition should be considered in the initial differential diagnosis of an adolescent presenting with fever , difficulty ambulating , and hip pain . This is a retrospective review of 8 cases of primary pelvic pyomyositis in patients aged 18 years or younger who were treated at the Children 's Medical Center in Augusta , Georgia . The site of infection was the obturator internus in the majority of the cases (5 ). The site was the gluteus , iliopsoas , and iliacus in 1 case each . Four patients who were diagnosed early responded to intravenous antibiotics with no need for further intervention . Two patients required incision and drainage of an abscess combined with antibiotics . Two patients had prolonged hospital courses requiring intensive unit care and mechanical ventilation . Blood cultures were positive in 87 .5 % of patients , and all patients presented with elevated acute phase reactants . One of the most difficult diagnostic aspects of presentation is an inconclusive symptom profile . It is noteworthy that patients with pelvic pyomyositis may present with limited range of motion in a specific plane (the motion placing the infected muscle on stretch ) vs global limited range of motion of the joint as is commonly seen in septic arthritis . Early diagnosis is essential to prevent systemic illness and complications associated with this condition . Magnetic resonance imaging with gadolinium is helpful to diagnose and guide treatment .