Clinical and Imaging Findings of Musculoskeletal Melioidosis in the Right Hip: A Case Report

Myung Hyun Kim; Tong Jin Chun

doi:10.3348/jksr.2018.78.3.212

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Kim and Chun: Clinical and Imaging Findings of Musculoskeletal Melioidosis in the Right Hip: A Case Report

Case Report

J Korean Soc Radiol 2018;78(3):212-219.

Published online: 20 January 2018

DOI: https://doi.org/10.3348/jksr.2018.78.3.212

Clinical and Imaging Findings of Musculoskeletal Melioidosis in the Right Hip: A Case Report

Myung Hyun Kim, MD, Tong Jin Chun, MD^∗

Department of Radiology, Eulji University Hospital, Daejeon, Korea

^∗Corresponding author: Tong Jin Chun, MD Department of Radiology, Eulji University Hospital, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea. Tel. 82-42-611-3564 Fax. 82-42-611-3590 E-mail: tchun@eulji.ac.kr

Received 11 April 2017 Revised 4 September 2017 Accepted 29 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Melioidosis is an infectious disease caused by a Gram-negative bacterium thought to be caused Burkholderia pseudomallei. This disease is endemic in tropical regions, but is not endemic and is rarely encountered in Korea. Nevertheless, the importance of early diagnosis of melioidosis is drawing substantial attention, due to its proliferation and the high mortality caused by the disease. Melioidosis can attack any organ, and manifests with a variety of symptoms. In particular, musculoskeletal melioidosis is rare and presents with nonspecific musculoskeletal symptoms. The imaging features of musculoskeletal melioidosis manifest a form of osteomyelitis or septic arthritis with soft tissue abscess or can mimic a bone tumor. This study describes the clinical and imaging findings of melioidosis involving the right femur and hip joint in a 64-year-old man.

Keywords: Index terms Melioidosis Burkholderia Pseudomallei Osteomyelitis Femur Infection

References

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Fig. 1.

A 64-year-old melioidosis patient with right hip pain. A. Initial and 3 weeks follow-up radiography images including the right hip show no abnormal findings on soft tissue or bony structure. B. Whole body bone scan shows multifocal increased uptake in the greater and lesser trochanter of the right femur, and weak uptake in the femoral head. A 64-year-old melioidosis patient with right hip pain. C. MRI shows abnormal lesion on the right proximal femur. Fat-suppressed T2-weighted MRI shows heterogeneously high signal intensity and T1-weighted MRI and proton density-weighted MRI show heterogeneously low signal intensity in the inferior portion of the femoral head, neck, greater and lesser trochanter, and the proximal shaft of the femur. Some areas that showed high signal intensity on T2-weighted MRI did not show enhancement. These non-enhanced areas are thought to consist of necrotic tissues. Contrast enhancement is observed not only in bone but also in surrounding soft tissue and iliopsoas bursa. MRI = magnetic resonance imaging A 64-year-old melioidosis patient with right hip pain. D. Magnetic resonance image shows prominent synovial thickening and enhancement with increased joint effusion in the right hip joint.

Fig. 1.

A 64-year-old melioidosis patient with right hip pain. E. Positron emission tomography/computed tomography shows multifocal hypermetabolic lesion on the proximal shaft of the femur, femur neck, femoral head and iliopsoas bursa. F. Post-excisional biopsy radiography (left) shows fracture of the lesser trochanter of the right femur and an irregular shaped radiolucent area on the right proximal shaft of the femur. This is thought to be due to the excisional biopsy. Post-re-operative radiography (right) shows widened radiolucent area on the proximal shaft of the femur where the drainage catheter tip is located. This indicates that an abscess is formed in this radiolucent lesion.

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