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 becoming more prevalent in the context of immunosuppression and diabetes and it is known to show a preponderance for pelvic girdle muscles. We present a case of a primary infective pyomyositis of the gluteal musculature in a diabetic patient which presented initially as a typical greater trochanteric bursitis. Case Report: A 52 year old female presented with sudden onset left lateral thigh pain localized to the greater 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 raised CRP of 92 with a normal white cell count. MRI confirmed an ill-defined collection overlying the gluteal tendon insertions with extensive surrounding oedema. The patient was surgically managed and underwent incision and drainage through a direct lateral incision. Samples sent were positive for staphylococcus aureus and the patient was commenced on IV flucloxacillin. They progressed to a full recovery. Conclusion: We recommend that consideration be given to infective pyomyositis in the differential for patients presenting acutely with trochanteric hip pain. Pyrexia, raised inflammatory markers and a history of diabetes mellitus or other immunosuppressive conditions should raise clinical suspicion for occult infection even in the setting of a common clinical complaint such as trochanteric hip pain. MRI is essential in achieving early diagnosis and surgical drainage and medical management can lead to a good clinical recovery.