Infectious Pyomyositis Results in Full Hip Disarticulation

Michael Talve, CEO

Written by
— Updated on August 14, 2017

This case involves a twenty-five-year-old female patient who sustained a puncture wound on her foot while vacationing in the Caribbean. The patient presented to her family doctor with complaints of severe pain at the site of the injury and on the dorsal aspect of her foot. The patient was given a tetanus shot, some pain medication, and was sent home. A few days later, the patient went to the emergency room for excruciating pain in the foot, and the ER physician ordered X-rays that were negative. The patient was once again given pain medication and sent home without antibiotics. Several days after, she was rushed back to the hospital by ambulance due to intractable foot pain. The patient finally received a biopsy and culture of the wound that showed infectious pyomyositis from a staph etiology. Subsequently, the patient underwent multiple surgical debridements and had a full hip disarticulation as a result of delayed treatment.

Question(s) For Expert Witness

  • 1. How should this patient have been worked up to find a more timely diagnosis?

Expert Witness Response E-004446

MRI is the imaging modality of choice for the diagnosis of pyomyositis. MRI is helpful in differentiating pyomyositis from osteomyelitis. It is especially useful in differentiating early muscle inflammation from abscess formation. A biopsy should then be performed to confirm the diagnosis and identify the microbial culprit. Then it is the responsibility of the physician to promptly administer systemic antibiotics. This could eliminate the need for surgical drainage in selected cases. The choice of antibiotic is determined by identification of the causative organism. Antibiotics initially are given intravenously until clinical improvement is noted, followed by oral antibiotics for a total course of three weeks (eg, cefazolin or ceftriaxone IV followed by cephalexin PO).

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