Septic arthritis of the left hip with striking radiological findings
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* David Gareth Roberts
* Nick Boyce Cam
* Aneil Shenolikar

## Description

A 30-year-old female patient presented to casualty with a 3-week history of left groin and abdominal pain, general malaise and fever. Of note, she was 18 weeks pregnant and had a history of intravenous drug abuse.On clinical examination, the patient was in septic shock and her abdomen was globally tender with guarding. There was no palpable hernia or mass with in the groin, however, she had bilateral dry sinuses in the femoral triangles and raised haematological infection markers.The initial abdominal radiograph (figure 1) showed gas over the region of the left groin. Radiographs of the left hip, including a lateral (figure 2), revealed a fluid level above the hip joint with gas superiorly.This raised the concern of underlying suppurative infection and an urgent CT scan was arranged (figure 3). This demonstrated an extensive retroperitoneal collection extending from the origin of the psoas to the left hip and changes within the left femoral head.An emergency operation was performed where copious pus and necrotic tissue were debrided from the left hip, groin and lower abdomen. The left femoral head was necrotic, which required a Girdlestone’s procedure (figure 4). After several further operations and a prolonged spell in the intensive therapy unit, the patient is making a good recovery.There are multiple complications arising from parental drug use, some of which have severe consequences and are often diagnostically challenging.1 Diseases of the skin and soft tissues are the most common causes of hospital admission with complications including thrombosis, septic arthritis and necrotising fasciitis.2

![Figure 1](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2011/bcr.06.2011.4302/F1.medium.gif)

[Figure 1](http://casereports.bmj.com/content/2011/bcr.06.2011.4302/F1)

Figure 1 
The abdominal radiograph, showing gas in the left lower abdomen and groin.

![Figure 2](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2011/bcr.06.2011.4302/F2.medium.gif)

[Figure 2](http://casereports.bmj.com/content/2011/bcr.06.2011.4302/F2)

Figure 2 
The lateral radiograph of left hip, showing a fluid level and gas in the soft tissues.

![Figure 3](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2011/bcr.06.2011.4302/F3.medium.gif)

[Figure 3](http://casereports.bmj.com/content/2011/bcr.06.2011.4302/F3)

Figure 3 
A coronal image of the abdominal CT, showing evidence of bony destruction in the head of the left femur.

![Figure 4](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2011/bcr.06.2011.4302/F4.medium.gif)

[Figure 4](http://casereports.bmj.com/content/2011/bcr.06.2011.4302/F4)

Figure 4 
Anteroposterior radiograph of the left hip after Girdlestone’s operation.

## Footnotes

*   Competing interests None.

*   Patient consent Obtained.

## References

1.  Calder KK, Severyn FA. Surgical emergencies in the intravenous drug user. Emerg Med Clin North Am 2003;21:1089–116.
    
    [CrossRef](http://casereports.bmj.com/lookup/external-ref?access_num=10.1016/S0733-8627(03)00068-3&link_type=DOI) 
    
    [PubMed](http://casereports.bmj.com/lookup/external-ref?access_num=14708820&link_type=MED&atom=%2Fcasereports%2F2011%2Fbcr.06.2011.4302.atom) 
    
    [Web of Science](http://casereports.bmj.com/lookup/external-ref?access_num=000187318600015&link_type=ISI) 

2.  Pfefferkorn U, Viehl CT, Bassetti S, et al. Injection site abscesses in intravenous drug users. Frequency of associated complications related to localisation. Chirurg 2005;76:1053–7.
    
    [CrossRef](http://casereports.bmj.com/lookup/external-ref?access_num=10.1007/s00104-005-1042-x&link_type=DOI) 
    
    [PubMed](http://casereports.bmj.com/lookup/external-ref?access_num=15971034&link_type=MED&atom=%2Fcasereports%2F2011%2Fbcr.06.2011.4302.atom) 
    
    [Web of Science](http://casereports.bmj.com/lookup/external-ref?access_num=000233704000007&link_type=ISI)