Primary obturator pyomyositis

Background: The main objective of our work was to draw attention to the possible occurrence of a serious and life-threatening illness, primary pyomyositis of the obturator muscles in countries with a mild climate, and to establish basic diagnostic criteria for the illness, including differential diagnostics, and to propose a treatment method. Methods: The authors describe two cases (a boy of 11 and a woman aged 47 years) with the occurrence of primary pyomyositis of the obturator muscles in the Czech Republic and they focus on the most important clinical symptoms and imaging methods necessary for the establishment of the diagnosis. Results: Repeated clinical examinations are important for the establishment of the diagnosis, particularly the presence of the symptom triad (pain in the hip joint, limping, febrile state), positive inflammatory markers and, first and foremost, the demonstration of pyomyositis on CT or MR. Differential diagnosis must also consider inflammatory diseases of the locomotor system (coxitis, sacroiliitis, osteomyelitis), of the digestive tract (Crohn's disease, a tumour, an obturator hernia) and of the urogenital system (gonorrhoea). Conclusion: The therapy of pyomyositis must be initiated in time by bed rest and administration of antibiotics and, if an abscess develops, surgical intervention is unconditionally necessary, consisting either in percutaneous abscess puncture or incision, perfusion, and application of antibiotics. The failure to diagnose an abscess of the obturator muscles and late therapy can result in serious complications, septic shock and death.