Multifocal pyomyositis following normal vaginal delivery : a case-based report

Abstract

Here we present a rare case of a 38-year-old Caucasian primigravida with persistent pelvic pain postpartum after normal vaginal delivery. MR imaging was unremarkable and after being managed conservatively she was discharged on the fourth post-partum day. However, she represented two weeks later at the A&E department with features of sepsis, requiring an admission at the local intensive care unit. Repeat MR imaging showed multifocal pyomyositis affecting the right lower psoas and ipsilateral iliacus muscle, right multifidus and erector spinae musculature, ipsilateral piriformis and the gluteus maximus muscle. This was associated with septic arthritis of the sacroiliac joints. The patient was stabilised and started on potent broad-spectrum antibiotics. An incision and drainage was performed with pus cultures being positive for Escherichia coli and Streptococcus gallolyticus.

Despite treatment, patient was still febrile and subsequent MR imaging showed persistent abscess formation in the iliacus together with septic arthritis. A CT guided drain insertion to which she responded well. After this 16-day hospital stay the patient was discharged in a stable general condition, being able to maintain all her previous activities of daily living. She was followed up regularly at orthopedic outpatients.