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Osteomyelitis of Bilateral Femoral Heads After Childbirth: A Case Report.

Lee KS, Kong S, Kim J, Kim T, Choi CB, Kim YS, Lee KH - Ann Rehabil Med (2015)

Bottom Line: The patient described in this case suffered from severe hip pain after childbirth.The patient's clinical symptoms and laboratory findings improved with antibiotic therapy.However, limitation of motion of the bilateral hip joints persisted although the patient continued rehabilitative therapy for 15 months, and the patient had to undergo bilateral total hip replacement.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT
Hip and pelvic pain during pregnancy or after delivery is a common problem in young females, and in most cases this problem has a self-limiting course. The patient described in this case suffered from severe hip pain after childbirth. MR imaging study was performed and it showed arthritis of bilateral hip joints and osteomyelitis of femoral heads with an abscess in the surrounding muscle. Infection, such as septic arthritis or osteomyelitis, is an extremely rare cause of peripartum joint pain. The patient's clinical symptoms and laboratory findings improved with antibiotic therapy. However, limitation of motion of the bilateral hip joints persisted although the patient continued rehabilitative therapy for 15 months, and the patient had to undergo bilateral total hip replacement. Hereby, we present a case of severe osteomyelitis and pyogenic arthritis of bilateral femoral heads and hip joints after delivery, which eventually required bilateral total hip replacement.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance images of bilateral hips at one month after delivery. Coronal T2-weighted image shows a suspicious abscess in the right pectineus muscle (A), bilateral hip joint space narrowing with cortical destruction (arrow head), and surrounding soft tissue edema with enhancement and bilateral hip joint effusion (arrow) (B).
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Figure 2: Magnetic resonance images of bilateral hips at one month after delivery. Coronal T2-weighted image shows a suspicious abscess in the right pectineus muscle (A), bilateral hip joint space narrowing with cortical destruction (arrow head), and surrounding soft tissue edema with enhancement and bilateral hip joint effusion (arrow) (B).

Mentions: Antibiotic therapy with cefminox was started immediately and it was changed to cefmenoxime one week later because of sustained fever. The antibiotic therapy was continued for 5 weeks, and her body temperature returned to normal and laboratory results showed evidence of mild degree of inflammation. However, severe leukocytopenia due to antibiotic therapy was discovered and the patient was transferred to our institution for further management. MR images were re-obtained immediately, and they still showed osteomyelitis with pyogenic arthritis and surrounding myositis of bilateral hip joints, left pyogenic sacroiliitis, and a suspicious abscess in the right pectineus muscle (Fig. 2). We performed emergent ultrasonography (US)-guided aspiration from the pectineus muscle and it proved to be fluid collection and not an abscess. Analysis of joint fluid from the hip joint was also performed, and it demonstrated an increase in white blood cell count, red blood cell count, and lymphocyte count. However, no organism was isolated from the hip joint fluid. Her CRP level was 2.1 mg/dL and white blood cell count was 2,200/mm3 at the time of transfer.


Osteomyelitis of Bilateral Femoral Heads After Childbirth: A Case Report.

Lee KS, Kong S, Kim J, Kim T, Choi CB, Kim YS, Lee KH - Ann Rehabil Med (2015)

Magnetic resonance images of bilateral hips at one month after delivery. Coronal T2-weighted image shows a suspicious abscess in the right pectineus muscle (A), bilateral hip joint space narrowing with cortical destruction (arrow head), and surrounding soft tissue edema with enhancement and bilateral hip joint effusion (arrow) (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496524&req=5

Figure 2: Magnetic resonance images of bilateral hips at one month after delivery. Coronal T2-weighted image shows a suspicious abscess in the right pectineus muscle (A), bilateral hip joint space narrowing with cortical destruction (arrow head), and surrounding soft tissue edema with enhancement and bilateral hip joint effusion (arrow) (B).
Mentions: Antibiotic therapy with cefminox was started immediately and it was changed to cefmenoxime one week later because of sustained fever. The antibiotic therapy was continued for 5 weeks, and her body temperature returned to normal and laboratory results showed evidence of mild degree of inflammation. However, severe leukocytopenia due to antibiotic therapy was discovered and the patient was transferred to our institution for further management. MR images were re-obtained immediately, and they still showed osteomyelitis with pyogenic arthritis and surrounding myositis of bilateral hip joints, left pyogenic sacroiliitis, and a suspicious abscess in the right pectineus muscle (Fig. 2). We performed emergent ultrasonography (US)-guided aspiration from the pectineus muscle and it proved to be fluid collection and not an abscess. Analysis of joint fluid from the hip joint was also performed, and it demonstrated an increase in white blood cell count, red blood cell count, and lymphocyte count. However, no organism was isolated from the hip joint fluid. Her CRP level was 2.1 mg/dL and white blood cell count was 2,200/mm3 at the time of transfer.

Bottom Line: The patient described in this case suffered from severe hip pain after childbirth.The patient's clinical symptoms and laboratory findings improved with antibiotic therapy.However, limitation of motion of the bilateral hip joints persisted although the patient continued rehabilitative therapy for 15 months, and the patient had to undergo bilateral total hip replacement.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT
Hip and pelvic pain during pregnancy or after delivery is a common problem in young females, and in most cases this problem has a self-limiting course. The patient described in this case suffered from severe hip pain after childbirth. MR imaging study was performed and it showed arthritis of bilateral hip joints and osteomyelitis of femoral heads with an abscess in the surrounding muscle. Infection, such as septic arthritis or osteomyelitis, is an extremely rare cause of peripartum joint pain. The patient's clinical symptoms and laboratory findings improved with antibiotic therapy. However, limitation of motion of the bilateral hip joints persisted although the patient continued rehabilitative therapy for 15 months, and the patient had to undergo bilateral total hip replacement. Hereby, we present a case of severe osteomyelitis and pyogenic arthritis of bilateral femoral heads and hip joints after delivery, which eventually required bilateral total hip replacement.

No MeSH data available.


Related in: MedlinePlus