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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
.
Diseases
Validation
Diseases presenting
"pelvic pyomyositis"
symptom
pyomyositis
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