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Bilateral hip pain caused by adductor pyomyositis as the initial presentation of chronic myeloid leukemia in a 17-year-old child.
[pyomyositis]
Pyomyositis
is
a
pyogenic
muscular
tissue
infection
mainly
occurring
in
immunocompromised
patients
.
Chronic
myeloid
leukemia
(
CML
)
accounts
for
only
2
-
3
%
of
cases
of
childhood
leukemia
.
Herein
,
we
report
on
a
17
-
year
-old
male
with
bilateral
hip
pain
caused
by
adductor
pyomyositis
before
beginning
the
treatment
course
of
CML
.
CML
was
diagnosed
by
bone
marrow
chromosome
study
and
was
treated
initially
with
imatinib
but
switched
to
hydroxyurea
5
days
later
because
of
poor
cytoreduction
response
.
Subsequently
,
white
blood
cell
counts
decreased
gradually
;
however
,
the
hyperleukocytosis
condition
resolved
very
slowly
again
until
we
switched
back
to
imatinib
use
on
the
40
(
th
)
day
of
hospitalization
.
Pyomyositis
was
diagnosed
by
magnetic
resonance
imaging
.
Oxacillin
was
administered
to
cover
Staphylococcus
aureus
,
the
most
common
pathogen
of
pyomyositis
.
Bilateral
hip
pain
improved
within
72
hours
after
antibiotic
usage
,
but
follow-up
magnetic
resonance
imaging
after
15
days
of
treatment
revealed
well-defined
abscess
and
osteomyelitis
of
both
femoral
heads
.
Abscess
incision
and
drainage
were
performed
,
and
cultures
of
the
drained
pus
grew
no
microorganisms
.
The
patient
completed
5
weeks
of
oxacillin
treatment
after
the
operation
and
recovered
with
a
full
range
of
motion
of
both
hips
.
There
was
no
residual
disability
.
This
is
the
first
report
of
bilateral
hip
pain
caused
by
pyomyositis
as
the
initial
presentation
of
CML
.
Pyomyositis
needs
to
be
considered
in
the
differential
diagnosis
of
hip
pain
in
pediatric
patients
.
