Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2016; 7(5): 338-342
Published online May 18, 2016. doi: 10.5312/wjo.v7.i5.338
Methicillin-resistant Staphylococcus aureus infected gluteal compartment syndrome with rhabdomyolysis in a bodybuilder
Colin Y L Woon, Kushal R Patel, Benjamin A Goldberg
Colin Y L Woon, Kushal R Patel, Benjamin A Goldberg, Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL 60612, United States
Author contributions: Woon CYL designed the report and wrote the paper; Patel KR collected data and revised the paper; Goldberg BA revised and reviewed the paper for critical content.
Institutional review board statement: None.
Informed consent statement: The involved subject provided written informed consent for the study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Colin Y L Woon, MD, Department of Orthopaedic Surgery, University of Illinois at Chicago, 835 S. Wolcott Avenue, M/C 844, Chicago, IL 60612, United States. wolv23@gmail.com
Telephone: +1-312-9969858 Fax: +1-312-9969025
Received: February 3, 2016
Peer-review started: February 14, 2016
First decision: March 1, 2016
Revised: March 10, 2016
Accepted: March 24, 2016
Article in press: March 25, 2016
Published online: May 18, 2016
Processing time: 97 Days and 7.2 Hours
Abstract

Gluteal compartment syndrome (GCS) is a rare condition. We present a case of gluteal muscle strain with hematoma formation, methicillin-resistant Staphylococcus aureus (MRSA) superinfection, leading to acute GCS, rhabdomyolysis and acute kidney injury. This combination of diagnoses has not been reported in the literature. A 36-year-old Caucasian male presented with buttock pain, swelling and fever after lifting weights. Gluteal compartment pressure was markedly elevated compared with the contralateral side. Investigations revealed elevated white blood cell, erythrocyte sedimentation rate, C-reactive protein, creatine kinase, creatinine and lactic acid. Urinalysis was consistent with myoglobinuria. Magnetic resonance imaging showed increased T2 signal in the gluteus maximus and a central hematoma. Cultures taken from the emergency debridement and fasciotomy revealed MRSA. He had repeat, debridement 2 d later, and delayed primary closure 3 d after. GCS is rare and must be suspected when patients present with pain and swelling after an inciting event. They are easily diagnosed with compartment pressure monitoring. The treatment of gluteal abscess and compartment syndrome is the same and involves rapid surgical debridement.

Keywords: Compartment syndrome; Rhabdomyolysis; Methicillin-resistant Staphylococcus aureus; Gluteal compartment; Acute kidney injury

Core tip: Gluteal compartment syndrome (GCS) is rare. Methicillin-resistant Staphylococcus aureus infected GCS with rhabdomyolysis and acute kidney injury has not been reported. Compartment pressure monitoring and magnetic resonance imaging are useful for the diagnosis of this condition. Successful management comprises surgical fasciotomy, debridement together with antibiotics.