Journal of

Case Reports and Images in Surgery

 
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Case Report
 
Infectious myositis of the iliacus muscle: An important differential in the unwell child with a limp
Alexander Martin1, Syed Aftab1, Urpinder Grewal1, Tom Pampiglione1, Thomas Bracewell1, Alice Macerola1
1Trauma and Orthopaedics Department, Barnet and Chase Farm Hospital, Royal Free London NHS Foundation Trust.

Article ID: 100005Z12AM2015
doi:10.5348/Z12-2015-5-CR-5

Address correspondence to:
Alexander Nicholas Martin
Trauma and Orthopaedics Department
Barnet and Chase Farm Hospital
Royal Free London
NHS Foundation Trust

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How to cite this article:
Martin A, Aftab S, Grewal U, Pampiglione T, Bracewell T, Macerola A. Infectious myositis of the iliacus muscle: An important differential in the unwell child with a limp. J Case Rep Images Surg 2015;1:17–20.


Abstract
Introduction: Infectious myositis is a rare entity with potential for significant complications. It is most commonly the result of hematogenous infection and develops in areas compromised by trauma, foreign body, ischemia or surgery. Several cases have been reported in equatorial climates, whilst infectious myositis remains rare in temperate climates. Infectious myositis of the iliacus muscle in a child has only been described once previously in British Orthopedic literature. We present a case of infectious myositis of the iliacus muscle in a child, diagnosed clinically and radiologically.
Case Report: A 13-year-old boy presented to the emergency department with a 24-hour history of feeling generally unwell, fevers and difficulty bearing weight on his right leg. On examination, the patient was pyrexial, appeared systemically unwell, had exquisite tenderness centered over the right anterior superior iliac spine (ASIS) and moderately reduced range of movement of his right hip, with hip extension most affected. Widespread eczematous skin lesions were noted, with a localized area of erythema, crusting and ooze on the dorsal aspect of the patients right foot. Inflammatory markers were raised on admission. Serial blood cultures were taken in addition to skin 28 swabs from the right foot. Whilst blood cultures were negative, the skin swab grew Acinetobacter lwoffii. Urgent MRI scan was performed which revealed changes consistent with infectious myositis of the right iliacus muscle. Parenteral antibiotic therapy was initiated following which prompt symptom resolution occurred. Subsequent MRI scan assessment six weeks following discharge displayed resolution of radiological changes.
Conclusion: This case represents a rare clinical diagnosis. We have demonstrated the difficulty in differentiating septic hip arthritis from myositis of the pelvic musculature. Furthermore, the importance of timely MRI investigation in delineating foci of soft tissue infections and enabling exclusion of possible differential diagnoses has been reinforced.

Keywords: Acinetobacter lwoffii, Infectious myositis, Pyomyositis, Paediatric


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Author Contributions
Alexander Martin – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Syed Aftab – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Urpinder Grewal – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Tom Pampiglione – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Thomas Bracewell – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Alice Macerola – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Alexander Martin et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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