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Postpartum periarticular hip abscess with later coxitis caused by group B streptococcus
A W Brandenberger1, R Hauser, L B Bronz
1Department of Obstetrics and Gynaecology, Ospedale San Giovanni, Bellinzona, Switzerland.
Abstract:
Intrapartum haematogenous spread of vaginal group B Streptococcus is rare, but it can lead to severe complications like abscesses, endocarditis and meningitis postpartum. We report a postpartum periarticular hip abscess caused by group B Streptococcus. Clinically it caused pain in the hip and a compression of the femoral nerve with motor and sensory component. Diagnosis was made by aspiration under computed tomography control. The only sign of infection was an increased sedimentation rate. After antibiotic treatment the symptoms disappeared and the abscess vanished, but it was reactivated 4 months after delivery, leading to arthritis of the hip joint. Another antibiotic treatment was administered for 8 weeks. 17 months postpartum the patient is well, but a development of a secondary coxarthrosis can not be excluded.
Insights
Group B Streptococcus can rarely cause postpartum hip abscesses, leading to nerve compression and joint issues. Prompt antibiotic treatment resolved symptoms, but recurrence highlights the need for vigilance.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Intrapartum Group B Streptococcus (GBS) infection is uncommon but can cause severe postpartum complications.
- Hematogenous spread of GBS can lead to deep-seated infections such as abscesses, endocarditis, and meningitis.
Observation:
- A rare case of a postpartum periarticular hip abscess caused by GBS is presented.
- The patient experienced hip pain and femoral nerve compression, with only an elevated sedimentation rate as a sign of infection.
Findings:
- Diagnosis was confirmed via computed tomography-guided aspiration.
- Initial antibiotic therapy led to abscess resolution, but it recurred 4 months postpartum, causing hip joint arthritis.
- The patient is clinically well 17 months postpartum, though secondary coxarthrosis is a potential long-term complication.
Implications:
- This case underscores the potential for GBS to cause rare but severe musculoskeletal infections postpartum.
- Effective antibiotic management is crucial, but the risk of recurrence and long-term joint damage necessitates careful monitoring.
- Highlights the importance of considering GBS in postpartum patients presenting with unexplained hip pain and signs of infection.