Malta Medical Journal, 32 (1): Pages (2020) http://mmsjournals.org/index.php/mmj/article/view/144 The Editorial Board retains the copyright of all material published in the Malta Medical Journal. Any reprint in any form of any part will require permission from the Editorial Board. Material submitted to the Editorial Board will not be returned, unless specifically requested. Malta Medical Journal Volume 32 Issue 01 2020 CASE REPORT Multifocal pyomyositis following normal vaginal delivery A case based report Charmaine Lia, Chris Cremona, Ryan Giordimaina, John Thake, Charles Malia Azzopardi Here we present a rare case of a 38-year-old Caucasian primigravida with persistent pelvic pain postpartum after normal vaginal delivery. MR imaging was unremarkable and after being managed conservatively she was discharged on the fourth post-partum day. However, she represented two weeks later at the A&E department with features of sepsis, requiring an admission at the local intensive care unit. Repeat MR imaging showed multifocal pyomyositis affecting the right lower psoas and ipsilateral iliacus muscle, right multifidus and erector spinae musculature, ipsilateral piriformis and the gluteus maximus muscle. This was associated with septic arthritis of the sacroiliac joints. The patient was stabilised and started on potent broad-spectrum antibiotics. An incision and drainage was performed with pus cultures being positive for Escherichia coli and Streptococcus gallolyticus. Despite treatment, patient was still febrile and subsequent MR imaging showed persistent abscess formation in the iliacus together with septic arthritis. A CT guided drain insertion to which she responded well. After this 16-day hospital stay the patient was discharged in a stable general condition, being able to maintain all her previous activities of daily living. She was followed up regularly at orthopedic outpatients. Charmaine Lia * M. D. Mater Dei Hospital Msida, Malta charmainetanti27@gmail.com Chris Cremona M.D. (Melit), MSc Surgery (Melit) Mater Dei Hospital Msida, Malta Ryan Giordimaina M.D. (Melit), FEBOT, FRCS (Trauma & Orth) (Edinburgh Mater Dei Hospital Msida, Malta John Thake MD, FRCOG. Department of Obstetrics and Gynaecology Charles Malia Azzopardi MD, FRCP, DTM&H Department of Medicine, Mater Dei Hospital Msida, Malta *Corresponding author MMJ 99