Refractory Buttock Pain: A Possible Sign of Severe Soft Tissue Infection

Abstract

The patient was a 72-year-old woman who had started to feel left buttock pain 10 days prior to admission to our hospital. She visited a local clinic, where a pain killer was prescribed. However, her pain deteriorated, expanding to her back and left leg, and she became unable to walk. Thus, she was transported to our hospital. She had diabetes mellitus, dyslipidemia, chronic heart failure, and lumbar spinal canal stenosis. She was initially diagnosed with sciatic neuralgia due to lumbar spondylosis and treated with acetaminophen and returned home. The next day, however, she developed bilateral leg paralysis and difficulty speaking. When the emergency medical technicians checked her, she was in cardiac arrest. On arrival at our hospital, she obtained spontaneous circulation but ultimately died. Whole-body computed tomography revealed gas deep in the left buttock, the bilateral psoas muscles and spinal canal. A blood culture later revealed Escherichia coli infection. Physicians should pay attention when patients with a high pain threshold, including those who are elderly, female or who have diabetes mellitus, complain of refractory buttock pain.