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Periprosthetic Clostridium difficile hip abscess imaged with In-111 WBCs
1Department of Radiology, New England Medical Center, Boston, Massachusetts.
Clinical Nuclear Medicine
|October 1, 1994
Summary
A patient with sickle cell disease developed an unusual hip abscess. Imaging revealed white blood cell accumulation, confirmed as Clostridium difficile infection during surgery.
Area of Science:
- Infectious Diseases
- Nuclear Medicine
- Orthopedic Surgery
Background:
- Sickle cell disease (SCD) patients are susceptible to infections.
- Bilateral hip prostheses increase the risk of periprosthetic joint infections (PJIs).
Observation:
- A woman with SCD and bilateral hip prostheses developed left hip pain during hospitalization.
- In-111 labeled white blood cell (WBC) scintigraphy and Tc-99m SC bone marrow imaging showed abnormal WBC accumulation around the left greater trochanter.
Findings:
- Surgical exploration revealed an abscess involving the pseudocapsule, trochanteric bursa, and periprosthetic cement.
- Cultures identified Clostridium difficile as the causative pathogen, an uncommon organism in this anatomical location.
Implications:
- This case highlights the importance of considering unusual pathogens in PJIs, especially in immunocompromised patients like those with SCD.
- Advanced imaging techniques are crucial for diagnosing PJIs in complex cases.
- Prompt surgical intervention and targeted antimicrobial therapy are essential for managing PJIs.