A limping child, a rare diagnosis, a remarkable recovery
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1
New Cross Hospital, United Kingdom
We report of an unusual case of acute infective adductor myositis in a healthy child, following trauma to the muscles of the medial thigh compartment.{BR}A 9 year old boy presented with four days of limping and progressive right hip pain, associated with high grade pyrexia. A history of groin trauma was reported. He has no past medical history. The child was unable to weight-bear, had right groin tenderness and very limited active right hip movements. Passive right hip movements were painful and restricted, particularly internal rotation and adduction. Blood results showed a Raised Erythrocyte Sedimentation rate (ESR), C-Reactive Protein (CRP) and Creatine Protein Kinase (CPK), with normal White Cell Count (WCC). Ultrasound excluded septic arthritis and did not reveal any other pathology. {BR}The child remained unwell despite broad-spectrum intravenous antibiotics and adequate analgesia. Magnetic resonance imaging demonstrated florid abnormality in right obturator externus, adductor brevis and adductor magnus muscle, but no definite well-formed abscess. Blood cultures revealed Staphylococcus aureus. He was treated with intravenous narrow-spectrum antibiotics for five days and then switched to oral antibiotic therapy. He was followed-up with weekly bloods and made a very good recovery.{BR}Classically, infective myositis has been a tropical disease. The incidence has been increasing worldwide due to Human Immunodeficiency Virus (HIV) emergence and immunosuppression.{BR}This is a rare presentation as the boy was not immunocompromised, and the trauma sustained may be implicated in the pathogenesis. Nonetheless, it is likely that the trauma was coincidental with the disease process. Furthermore, to our knowledge, no case has previously reported post-traumatic bacterial myositis in this muscle group.{BR}Limping due to hip pain is a common complaint in children. The diagnosis-making process depends on many factors, including the age of the child and clinical presentation. This case illustrates the importance of early magnetic resonance imaging in patients that remain unwell, despite excluding septic arthritis. Moreover, it may support the evidence of trauma involvement in the disease aetiology and progression.
Keywords:
Bones,
Bone Research
Conference:
2011 joint meeting of the Bone Research Society & the British Orthopaedic Research Society, Cambridge, United Kingdom, 27 Jun - 29 Jun, 2011.
Presentation Type:
Poster
Topic:
Abstracts
Citation:
Koushiappi
E,
Abbas
R and
Mughal
E
(2011). A limping child, a rare diagnosis, a remarkable recovery.
Front. Endocrinol.
Conference Abstract:
2011 joint meeting of the Bone Research Society & the British Orthopaedic Research Society.
doi: 10.3389/conf.fendo.2011.02.00037
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Received:
30 Sep 2011;
Published Online:
30 Sep 2011.
*
Correspondence:
Dr. E Koushiappi, New Cross Hospital, Wolverhampton, United Kingdom, e.koushiappi@nhs.net