1312 Fig. 1 Transversal Turbo Spin Echo T2 weighted image with fat saturation shows a large infiltrate in the gluteus maximus muscle on the right side fornix and the posterior pelvic soft tissues paramedian to the right and a large infiltrate in the gluteus maximus muscle on the right side (Fig. 2). At first, the patient was submitted to the internal ward and was treated with three daily 1.2 g amoxicillin/ clavulanic acid intravenous. Because of the suspicion of a gynaecologic cause of the infection, clindamycin 600 mg intravenous was added three times a day, and she was presented to our department. Vaginal examination and transvaginal ultrasound strengthened the presumption of the myositis caused by a gynaecological cause, possibly the sacrospinous ligament fixation performed 1 year ago. The patient continued her antibiotic treatment and started with local and oral estrogens to reduce vaginal atrophy, which could have been the cause of a port d’entree for the infection with a group A streptococci, which was found in the vaginal culture. Although the admission was compli- cated by a lower respiratory tract infection, wherefore the antibiotics were changed to three daily 1 g ceftazidine instead of amoxicillin/clavulanic acid, She made a good recovery at the conservative treatment with antibiotics intravenous. The fever lowered the first day after admis- sion, the pain in her right buttock diminished and the white blood cell count and C-reactive protein decreased. After 18 days of admission, the patient was in a good clinical condition without any pain or fever, her white blood cell count was decreased to 4.1 × 109/l and the C- reactive protein was decreased to 8 mg/l. The magnetic resonance imaging showed a regression of the myositis, but there was still an infiltrate visible in the gluteal region with a fistula from the cervical canal to the gluteal region. The same day the patient was discharged with a prescription for Int Urogynecol J (2008) 19:1311–1313 two daily 500 mg ciprofloxacin, three daily 600 mg clindamycin and local estrogens. After her admission, the patient was reviewed at the gynaecology clinic several times and was well with no reported symptoms of pain, fever or vaginal discharge. The magnetic resonance imaging has not been repeated, but during vaginal examination and ultrasound, there were no clear signs of the fistula or myositis seen. Discussion The causes of a myositis can be multiple and can be divided into those in which a causative infective organism can be identified and those in which the cause is unknown. In this case, two reasonable explanations of the myositis should be considered. Because a group A streptococci was found in the vaginal culture and suspect to have caused the myositis and because the magnetic resonance imaging indicates a fistula between the vaginal apex and the infected gluteal region, the possibility of a port d’entree in the vagina through vaginal atrophy via the non-resorbable sutures to the gluteal region would be the most reasonable explana- tion. But there is also a chance that the disinfection and prophylactic use of antibiotics during the original sacrospi- nous fixation failed and a late onset post-operative infection could be the case. This report is the first case describing a myositis of the gluteal region as a late onset complication of a sacrospinous ligament fixation with uterine preservation. Furthermore, Fig. 2 Sagittal Turbo Spin Echo T2 weighted image with fat saturation demonstrates a fistula between the posterior fornix and the perineum slightly paramedian to the right. The black stripe at the level of the cervix is suture material