Primary Septic Greater Trochanteric Bursitis

Sir,

Greater trochanteric (GT) bursitis arising from noninfectious etiologies is well-documented;[1] however, reports describing septic GT bursitis are scarce.[2,3,4,5] An 81-year-old man presented with acute lateral hip pain following the initiation of twisting exercises. There were no visible skin abnormalities and no history of invasive procedures. Upon palpation, the hip demonstrated trochanteric bursa swelling and tenderness. Clinically presenting as acute aseptic GT bursitis, triamcinolone acetonide was injected into the left superficial GT bursa. Afterward, an abnormally large amount of cloudy fluid leaked from the injection site. The bursa was aspirated, and 2 ml of yellow, semi-purulent fluid was obtained and sent for aerobic and anaerobic culture. The patient was placed on prophylactic antibiotics (sulfamethoxazole-trimethoprim DS). Lab work demonstrated a sedimentation rate of 54 mm/h and a C-reactive protein level of 161.0 mg/l. The culture revealed methicillin-sensitive Staphylococcus aureus, supporting the diagnosis of septic GT bursitis. With oral antibiotics alone, the condition resolved in 2.5 weeks. From this information, the authors conclude that the twisting exercises irritated and inflamed the GT bursa, and the collected fluid became seeded with bacteria. Therefore, deep bursal infections should be considered with acute lateral hip pain, especially following activities that could cause repetitive micro-trauma.