A 61-year-old man with a past medical history significant for metastatic rectal cancer treated with local resection, chemotherapy, and radiation complicated by vesicocutaneous fistula presented with subacute ambulatory dysfunction secondary to right hip pain. Imaging studies were consistent with a right hip effusion, and fluoroscopyguided hip aspiration revealed septic arthritis caused by Pseudomonas aeruginosa. Resistance patterns identified this strain of Pseudomonas to be the same one that caused pyelonephritis that was treated during the same hospitalization. Although further diagnostic imaging was not pursued, the presentation was most consistent with vesico-acetabular fistula causing native hip septic arthritis. This is a very rare complication of radiation therapy that serves as a reminder to keep a broad differential for atypical presentations in patients who have undergone extensive local radiation.
Sturzoiu, MD, Tudor
"A Case of Native Hip Pseudomonas aeruginosa Septic Arthritis Caused by Vesico-acetabular Fistula,"
The Medicine Forum: Vol. 22, Article 9.
Available at: https://jdc.jefferson.edu/tmf/vol22/iss1/9