ABSTRACT
Groin pain is a frequently occurring complaint in presentations to the Emergency Department. Muscular sprain is often a differential diagnosis, however serious conditions such as pyomyositis should not be ignored. This case report presents a child with atraumatic right groin pain, which was initially diagnosed as a muscular sprain. The patient later re-presented out of hours to the Emergency Department with what was found to be extensive pelvic abscesses. He was subsequently found to have bilateral pneumonia and later developed a pericardial effusion and osteomyelitis of the right iliac bone, sacroiliac joint and sacrum. With multiple surgical interventions and appropriate antibiotics, he made a full recovery and was discharged home after a total admission time of 41 days. The causative organism was found to be Panton-Valentine leucocidin-positive methicillin-susceptible Staphylococcus aureus.
Subject(s)
Abscess/microbiology , Bacterial Toxins/biosynthesis , Exotoxins/biosynthesis , Leukocidins/biosynthesis , Osteomyelitis/microbiology , Pneumonia, Staphylococcal/microbiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/metabolism , Abdomen/diagnostic imaging , Abscess/complications , Abscess/diagnostic imaging , Abscess/surgery , Adolescent , Anti-Bacterial Agents/therapeutic use , Bacterial Toxins/isolation & purification , Exotoxins/isolation & purification , Humans , Ilium/diagnostic imaging , Leukocidins/isolation & purification , Lung/diagnostic imaging , Magnetic Resonance Imaging , Male , Methicillin Resistance , Microscopy, Acoustic , Osteomyelitis/complications , Osteomyelitis/diagnosis , Pneumonia, Staphylococcal/complications , Pneumonia, Staphylococcal/diagnosis , Staphylococcal Infections/complications , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purificationABSTRACT
Intermittent facial swelling is an unusual presentation in the emergency department. The differential diagnosis may range from a variety of causes. Most common differential diagnosis is angio-oedema. However, more serious presentations such as superior venacaval obstruction must not be ignored. This case report presents a patient who was investigated in the hospital for 2 weeks (2 admissions) with intermittent facial swelling. He presented to the emergency department (3rd admission) and was diagnosed to have superior venacaval obstruction secondary to metastatic bronchogenic carcinoma. He underwent emergency endovascular stenting; however, he died within a few weeks.
