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Case Reports
. 2017 May 22:2017:bcr2016218474.
doi: 10.1136/bcr-2016-218474.

Pathological fracture of the femoral neck following septic coxitis and chronic osteomyelitis: a potential complication of Lemierre's syndrome

Dominik Maximilian Vogt  1 , Ludger Tüshaus  2 , Martin Kaiser  2 , Martin Russlies  1
Affiliations
Case Reports

Pathological fracture of the femoral neck following septic coxitis and chronic osteomyelitis: a potential complication of Lemierre's syndrome

Dominik Maximilian Vogt et al. BMJ Case Rep. .

Abstract

We portray the case of a 16-year-old girl who was initially admitted to the paediatric emergency department with non-specific symptoms of a severe cold and was first treated symptomatically on an ambulatory basis. Within 6 days she developed the full clinical picture of Lemierre's syndrome with the extraordinary manifestation of involvement of her right hip. Despite an interdisciplinary coordinated treatment as well as surgical therapy, a full-blown sepsis evolved within a short time period and resulted in almost 2 months of intensive care. While the primary focus could be successfully controlled, a progressive avascular necrosis of the right proximal femur developed on the basis of a chronic osteomyelitis. This finally led to a pathological fracture of the femoral neck. After excluding the possibility of an enduring bacterial infection, the fracture was treated with a total hip replacement.

Keywords: Bone and joint infections; Ear, nose and throat/otolaryngology; Orthopaedics; Paediatrics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Radiological findings on admission: (A) MRI of the neck with a contrast agent showing a left-sided parapharyngeal abscess, (B) X-ray of the right hip with normal findings and (C) MRI showing an effusion of the right hip joint.
Figure 2
Figure 2
(A) MRI of the right hip showing an abscessing myositis, fasciitis and osteomyelitis of the proximal femur with reduced perfusion of the femoral head. (B) X-ray control following drilling of the medullary cavity of the proximal femur and implantation of gentamicin Polymethyl methacrylate (PMMA) chains.
Figure 3
Figure 3
(A) MRI and (B) Single-photon emission computed tomography showing the persistence of inflammation and an incipient osteonecrosis of the femoral head and neck.
Figure 4
Figure 4
X-rays showing (A) the pathological fracture of the femoral neck, (B) the antibiotic cement spacer and (C) the total hip replacement 2 weeks after implantation.
See this image and copyright information in PMC

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