Buldu Metin Tolga, Raman Raghu
Trauma and Orthopaedics Department, Hull Royal Infirmary, Anlaby Road, HU3 2JZ, United Kingdom.
J Clin Orthop Trauma. 2016 Oct-Dec;7(Suppl 1):69-71. doi: 10.1016/j.jcot.2016.07.002. Epub 2016 Jul 20.
The unique aspect of this case study is the unusual history, presentation, ultrasonography, MRI and blood culture results, which lead to the diagnosis and treatment of adductor pyomyositis with a rare organism in a temperate country. The patient presented with a one-day history of malaise, fever, left groin pain and inability to weight bear on the left leg. There was no history of any trauma, predisposing infections or recent travel. Plain radiograph and ultrasound of the hip was normal with no effusion. Two consecutive blood cultures suggested bacteraemia and MRI scan confirmed pyomyositis of the left hip adductors that was too small to drain. is a normal commensal organism however it can lead to opportunistic infections particularly endocarditis. Echocardiogram revealed no cardiac complications, in particular no endocarditic vegetation. Patient was treated with intravenous benzylpenicillin for a week followed by oral phenoxymethylpenicillin for a week. Adductor pyomyositis must be considered as a differential diagnosis in a child with unusual presentation of hip pain. When an ultrasound is normal, MRI scan is warranted to confirm diagnosis. Septic screen should include blood cultures. The commonest causative organisms are the Staphylococcus family. However if is isolated, cardiac sources of infection resulting in septic emboli must be investigated. Repeated MRI scans are required particularly if the patient does not respond to medical management.
IV.
本病例研究的独特之处在于其不寻常的病史、临床表现、超声检查、磁共振成像（MRI）及血培养结果，这些因素促成了在一个温带国家对罕见病原体引起的内收肌脓性肌炎的诊断与治疗。患者出现了为期一天的不适、发热、左腹股沟疼痛及无法负重行走的症状。既往无任何创伤、易患感染或近期旅行史。髋关节的X线平片和超声检查均正常，无积液。连续两次血培养提示菌血症，MRI扫描证实左髋内收肌脓性肌炎，但病灶过小无法引流。 是一种正常共生菌，但可导致机会性感染，尤其是心内膜炎。超声心动图显示无心脏并发症，尤其是无心内膜炎赘生物。患者接受了一周的静脉注射苄星青霉素治疗，随后口服苯氧甲基青霉素一周。对于出现髋关节疼痛异常表现的儿童，必须考虑内收肌脓性肌炎作为鉴别诊断。当超声检查正常时，需进行MRI扫描以确诊。感染筛查应包括血培养。最常见的病原体是葡萄球菌属。然而，如果分离出 ，则必须调查导致感染性栓子的心脏感染源。特别是在患者对药物治疗无反应时，需要重复进行MRI扫描。
IV级。
