Obturator internus pyomyositis: iatrogenic haematogenous spread

Area of Science:

• Pediatric infectious diseases
• Musculoskeletal infections
• Surgical management of pediatric infections

Background:

• Obturator internus pyomyositis is an uncommon deep-seated hip flexor infection.
• It presents with non-specific symptoms like fever, limp, and abdominal or groin pain in children.
• Early consideration in the differential diagnosis is essential for timely intervention.

Observation:

• A 5-year-old girl presented with symptoms suggestive of obturator internus pyomyositis.
• Initial medical management, including antibiotics, proved unsuccessful.
• The patient had a history of an infected, protruding elastic stable intramedullary nail in her forearm.

Findings:

• The patient underwent successful open surgical drainage of the infected obturator internus muscle.
• Cultures from the drainage confirmed bacterial infection.
• The forearm intramedullary nail was identified as the likely source of the hematogenous spread.

Implications:

• This case highlights the importance of considering obturator internus pyomyositis in pediatric patients with relevant symptoms.
• Prompt surgical intervention, such as open drainage, may be necessary when medical management fails.
• The potential for distant infected hardware to seed deep-seated infections warrants careful evaluation in pediatric cases.