Artritis séptica de la sacroilíaca secundaria a piomiositis supurativa

Eduardo Gallinas Maraña , Ignacio Puyuelo Jarne , Leyre López Fernández , Laura Cuadrado Piqueras , Jorge Martínez-Iñiguez Blasco
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Abstract

Pyomyositis is a subacute suppurative bacterial infection of muscle, caused by hematogenous spread and sometimes accompanied by the formation of abscesses. Although, it is a disease classically observed in tropical areas, in recent years an increase in its incidence has been described in temperate countries, especially in immunosuppressed people.

Its most frequent etiological agent is Staphylococcus aureus. The most common locations are the quadriceps, buttocks, and iliopsoas, the association with septic arthritis and osteomyelitis being exceptional.

In the pediatric population, it usually affects healthy people and athletes, and its appearance is related to intense physical exercise or minor trauma that, in many cases, can go unnoticed. The clinical presentation of acute pyomyositis is usually insidious, and can occur without fever, but with local symptoms such as pain, swelling, and functional limitation. Drainage of the abscess, followed by the administration of antibiotics leads to complete recovery. Primary pyomyositis is rare, and the diagnosis is delayed due to the deep location of the muscle and because the symptoms can confuse the diagnosis with septic arthritis of the hip.

We present this case due to the difficulty of its diagnosis and the complications derived from the delay in its diagnosis.

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化脓性肌炎是一种亚急性化脓性细菌性肌肉感染,由血液扩散引起,有时伴有脓肿的形成。虽然这是一种在热带地区常见的疾病,但近年来在温带国家,特别是在免疫抑制人群中,其发病率有所增加。其最常见的病原体是金黄色葡萄球菌。最常见的部位是股四头肌、臀部和髂腰肌,与化脓性关节炎和骨髓炎的关联是例外。在儿科人群中,它通常影响健康人和运动员,它的出现与剧烈的体育锻炼或轻微的创伤有关,在许多情况下,这些创伤可能被忽视。急性化脓炎的临床表现通常是隐匿的,可以不发热,但有局部症状,如疼痛、肿胀和功能限制。脓肿引流,然后给予抗生素治疗,可完全恢复。原发性化脓性肌炎是罕见的,由于肌肉的深层位置和症状可能混淆诊断为脓毒性髋关节关节炎而延误诊断。我们提出这一情况,由于其诊断的困难和并发症派生的延迟诊断。
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