[Gluteal abscess caused by Staphylococcus aureus in a patient with systemic lupus erythematosus]

We describe here a 44-year-old female patient with systemic lupus erythematosus (SLE), who developed gluteal abscess resulting in symptoms suggestive of aseptic necrosis of the right femoral head. The patient was diagnosed as active SLE with organic brain syndrome in December 1992, and has been treated with high doses of methylprednisolone (initial dose: 100 mg daily). As she recovered from the manifestations, the dose of methylprednisolone has been gradually decreased. In June 1993, she began to complain of right leg pain on walk with positive Patrick sign in the right hip. A massive gluteal abscess was identified by X-ray and CT scan, and drained. Cultures of the purulent fluid yielded Staphylococcus aureus. Of note, Staphylococcus aureus had been detected from repeated cultures of pharyngeal swabs, suggesting that the organism invading from the pharynx was carried in the blood to a small hematoma in the right gluteal muscle to form an abscess. The importance of an awareness of the possibility of the infection of Staphylococcus aureus in SLE patients is discussed.