Piriformis pyomyositis mimicking epidural abscess in a parturient

A case is presented of a patient who developed fever, leukocytosis, severe back pain, local overlying spinal tenderness, and left leg weakness on the fifth day postpartum. The patient had epidural anaesthesia for ten hours duration, before and during a forceps delivery. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) of the pelvis and lumbar spine revealed swelling of the left iliacus and piriformis muscles, but no epidural abscess. A diagnosis of isolated piriformis pyomyositis with secondary sciatic nerve irritation was made, and the patient was treated with intravenous antibiotics, non-steroidal anti-inflammatory agents, and morphine analgesia. She made a full, uneventful recovery within 50 days, and was discharged requiring no medications.