Primary Infective Pyomyositis of the Hip Abductors Presenting as Trochanteric Bursitis

Abstract

Introduction: Pyomyositis is an uncommon suppurative infection of skeletal muscle. In recent times, it is \nbecoming more prevalent in the context of immunosuppression and diabetes and it is known to show a \npreponderance for pelvic girdle muscles. We present a case of a primary infective pyomyositis of the gluteal \nmusculature in a diabetic patient which presented initially as a typical greater trochanteric bursitis. \nCase Report: A 52 year old female presented with sudden onset left lateral thigh pain localized to the \ngreater trochanteric region. Relevant comorbidities included a BMI of 35, uncontrolled non insulindependent diabetes mellitus and hypertension. Her HbA1c on presentation was 97mmol/mol. She had a \nraised CRP of 92 with a normal white cell count. MRI confirmed an ill-defined collection overlying the \ngluteal tendon insertions with extensive surrounding oedema. The patient was surgically managed and \nunderwent incision and drainage through a direct lateral incision. Samples sent were positive for \nstaphylococcus aureus and the patient was commenced on IV flucloxacillin. They progressed to a full \nrecovery. \nConclusion: We recommend that consideration be given to infective pyomyositis in the differential for \npatients presenting acutely with trochanteric hip pain. Pyrexia, raised inflammatory markers and a history \nof diabetes mellitus or other immunosuppressive conditions should raise clinical suspicion for occult \ninfection even in the setting of a common clinical complaint such as trochanteric hip pain. MRI is essential \nin achieving early diagnosis and surgical drainage and medical management can lead to a good clinical \nrecovery.