Adolescent Hip Pain Due to Iliopsoas Abscess

Hip pain in children and adolescents poses a diagnostic challenge due to various underlying causes, ranging from benign to severe conditions. Presented here is the case of an otherwise healthy 14-year-old boy who arrived at the emergency department with a two-day history of left hip pain, limping, fever, anorexia, and vomiting. Upon physical examination, tenderness was noted upon palpation of the left sacroiliac joint and with mobilization of the left lower limb. Elevated inflammatory markers raised suspicion of an osteoarticular infection. Despite initially normal imaging, subsequent MRI revealed an iliopsoas abscess, later confirmed by blood cultures positive for Staphylococcus aureus. A conservative management with antibiotics was selected due to the infeasibility of percutaneous or surgical drainage, leading to clinical improvement. This case highlights the efficacy of non-surgical approaches in selected situations and underscores the importance of a thorough evaluation, early suspicion of infection, appropriate imaging, and tailored antimicrobial therapy in managing hip pain in pediatric patients.