Primary Pyogenic Abscess in an Immunocompetent Child: An Indian Perspective.

Swapnil Keny, Harsh Parekh, Janki Chaudhary, Nikhil Gokhale, Nihar Modi
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Abstract

Introduction: Pyogenic psoas abscess (PPA) is a rare but severe condition. Previously linked to tuberculosis, it's now seen with diverse causes. This case report details the diagnosis and management of PPA in a healthy Indian child, initially suspected of having hip issues.

Case report: A 5-year-old girl was brought for pain in her right hip and lower back, and fever for 3 days. She was irritable and unable to walk. She was febrile (101°F), irritable, and toxic with her right lower limb flexed 30° at the hip with all its movements restricted and painful. Inguinal lymph nodes were palpable. Blood tests showed elevated white blood cell count (18,000 × 109/L) and inflammatory markers, with a negative Mantoux test. Radiographs of the lumbosacral spine were normal. Magnetic resonance imaging showed a large abscess in the right psoas and iliacus muscles, measuring 6.8 × 3.3 × 3 cm. She underwent open drainage through a retroperitoneal approach, and samples were sent for bacteriological analysis. The wound was irrigated and closed over a drain.Post-operatively, she received Linezolid being culture positive for methicillin-resistant Staphylococcus aureus. Her pain reduced by the 3rd day and she was discharged with oral antibiotics. She walked at 6 weeks and was symptom-free on follow-up.

Conclusion: This case highlights the crucial need to consider PPA in children showing hip pain, limping, and infection signs. Due to its subtle presentation and similarity to septic arthritis, high suspicion is essential. Timely imaging and proper treatment, such as drainage and antibiotics, can ensure positive results.

原发性化脓性脓肿在免疫能力的儿童:一个印度的观点。
摘要化脓性腰肌脓肿(PPA)是一种罕见但严重的疾病。以前与肺结核有关,现在被认为有多种原因。本病例报告详细介绍了一名健康的印度儿童PPA的诊断和治疗,最初怀疑患有髋关节问题。病例报告:一名5岁女童因右臀部及下背部疼痛及发热3天入院。她脾气暴躁,不能走路。患者发热(101°F)、易怒、中毒,右下肢髋部屈曲30°,所有活动受限且疼痛。可触及腹股沟淋巴结。血液检查显示白细胞计数(18000 × 109/L)和炎症标志物升高,曼图克斯试验阴性。腰骶骨x线片正常。磁共振示右侧腰肌、髂肌大脓肿,大小为6.8 × 3.3 × 3cm。她通过腹膜后入路进行开放引流,并送样本进行细菌学分析。伤口经冲洗后用排水管封好。术后,患者接受利奈唑胺耐甲氧西林金黄色葡萄球菌培养阳性。第3天疼痛减轻,口服抗生素出院。6周时行走,随访时无症状。结论:本病例强调了在出现髋关节疼痛、跛行和感染症状的儿童中考虑PPA的关键必要性。由于其微妙的表现和相似的化脓性关节炎,高度怀疑是必要的。及时的影像学检查和适当的治疗,如引流和抗生素,可以确保阳性结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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