title: Metastatic muscle abscesses complicating infected total hip arthroplasty.
abstract: A 73-year-old woman with rheumatoid arthritis presented to our institution with infection of her right total hip arthroplasty. On admission, a draining sinus tract over the hip and a palpable mass in the left lower posterior region of the neck were detected. The contrast CT scan showed a large abscess in the trapezius muscle and multiple abscesses involving muscle of the neck and right shoulder. Intraoperative specimens from the muscle abscess were positive for presumably the same methicillin-resistant Staphylococcus aureus that sustained the prosthetic joint infection. Prolonged intravenous daptomycin led to remission of the muscle abscess and control of the prosthetic joint infection. The patient refused revision total hip arthroplasty and oral cotrimoxazole was prescribed for chronic suppression of the infection. Three years after the primary surgery there was stable remission of the prosthetic joint infection. This rare case demonstrates the severity of prosthetic joint infections sustained by multiresistant bacteria in immunocompromised hosts, which may result in their bacteraemic spread.
authors.affiliation: Department of Public Health, School of Medicine, Federico II University, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Balato
authors.affiliation: Department of Infectious Diseases, D. Cotugno Hospital, AORN dei Colli, Naples, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Ascione
authors.affiliation: Department of Public Health, School of Medicine, Federico II University, Naples, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mariconda
authors.affiliation: Department of Infectious Diseases, D. Cotugno Hospital, AORN dei Colli, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pagliano
mesh_terms: D000038:Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D017576:Daptomycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D009334:Neck Muscles / Q000382:microbiology / Q000473:pathology; D012307:Risk Factors; D012782:Shoulder / Q000382:microbiology / Q000473:pathology; D013203:Staphylococcal Infections / Q000150:complications*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D064171:Superficial Back Muscles / Q000382:microbiology / Q000473:pathology; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017576:Daptomycin