Case report 1

A previously fit and well 24 year old fitness trainer presented with a three day history of increasing leg weakness and pain in his groin and gluteal regions, accompanied by fever and rigors. He had had a dental extraction one month before, without consequence.

On examination he had a temperature of 38.6°C and weakness of hip flexion of 3/5 on the MRC scale, but with normal tone, power, reflexes, and sensation elsewhere. His C reactive protein concentration was 142 mg/l, creatinine kinase concentrations were normal, and his lumbar spine radiograph was unremarkable. The differential diagnosis included transverse myelitis; therefore urgent magnetic resonance imaging of the spine and blood cultures were arranged.

Two days later he was bedridden and remained feverish. Repeat examination showed that he had no true leg weakness but had painful restriction of movement secondary to point tenderness over the symphysis pubis. Blood cultures were positive for Staphylococcus aureus and he was given intravenous flucloxacillin and rifampicin. An echocardiogram and abdominal ultrasound scan showed no source of infection, but an …