Epidemiological features and outcomes of patients with psoas abscess: A retrospective cohort study

Psoas muscle abscess as initial manifestation of disseminated tuberculosis in a previously healthy man: a case report

Psoas muscle abscess is an insidious disease, with varied clinical manifestations and a challenging diagnosis. This pathology has been more frequently identified due to the increased availability of high-quality radiological imaging, such as computed tomography. In Brazil, Mycobacterium tuberculosis is the most common secondary etiologic agent of psoas abscess. We report the case of a 28-year-old immunocompetent man diagnosed with disseminated tuberculosis, affecting the lungs, lumbar spine, and psoas muscle, leading to permanent locomotion sequelae. This case is very relevant for osteoarticular complaints, as low back pain and limping were the initial symptoms. Diagnosis was confirmed by ultrasound-guided percutaneous drainage of the psoas muscle abscess and detection of the M. tuberculosis complex via Xpert MTB/RIF. A 12-month treatment with antitubercular drugs was effective.

Primary Iliopsoas Abscess and Drug-Induced Liver Injury in the Emergency Department: A Case Report

BACKGROUND AND OBJECTIVE

Iliopsoas abscess (IPA) is a rare condition with varied symptomology and etiology. Less than one-third of patients with IPA present in the emergency department (ED) with the traditional triad of fever, back pain, and restricted hip motion (or limp), leading to delays in diagnosis and management. Acute liver failure is also a rare clinical presentation in the ED, being associated with high morbidity and mortality. It occurs most often in young patients without pre-existing liver disease, presenting unique challenges in clinical management. Most cases currently happen because of drug-induced liver injury (DILI), mainly from acetaminophen or idiosyncratic drug reactions. This case report aims to raise awareness among healthcare professionals regarding the two atypical presentations in ED and introduce a potential differential diagnosis when evaluating patients with fever and back pain or liver enzyme elevations with or without nonspecific symptoms associated with the development of jaundice. The intention is to provide insights into the signs and symptoms that may indicate the presence of an iliopsoas abscess and prompt additional investigations.

CASE REPORT

Here, we describe a case of primary iliopsoas abscess associated with drug-induced liver injury in our ED. The patient complained of pain in the left lumbar region and fatigue that started two weeks before this presentation, claiming that, during the previous night, the pain suddenly worsened. At the first clinical examination in the ED, the patient presented pain at palpation in the right hypochondriac and left lumbar regions, accompanied by fever, vomiting, and jaundice. On abdominal ultrasonography, the diagnosis of acute cholangitis was suspected. The laboratory test shows leukocytosis with neutrophilia, thrombocytosis, elevated liver enzymes, and hyperbilirubinemia with the predominance of indirect bilirubin. After analyzing the laboratory test results, we repeated and performed a more detailed anamnesis and medical history of the patient. Because of her increasing pain and persistent fever, she recognized excessive consumption in the last five days of drug-induced hepatotoxicity. We performed abdominal and pelvic computed tomography, which confirmed the diagnosis of cholelithiasis observed with the diameter of the bile duct within normal limits but also showed an abscess collection fused to the interfibrillar level of the left iliopsoas muscle, a diagnosis we most likely would have missed. The patient was hospitalized in the General Surgery Department, and surgical abscess drainage was performed. The patient's evolution was excellent; she was discharged after 11 days.

CONCLUSIONS

The case presented here exemplifies how iliopsoas abscess, a rare cause of back pain, can quickly go unrecognized, especially in the emergency department. Our experiences will raise awareness among doctors in emergency departments about this uncommon but essential diagnosis. With advancements in diagnostic tools and techniques, we hope that more cases of iliopsoas abscess will be accurately diagnosed. Moreover, no case report from the literature has presented IPA associated with DILI. This case is unique because our patient did not exhibit classic features of either pathology. This case also emphasizes the importance of a medical history that includes thorough evaluations of potential high utilization of drug-induced hepatotoxicity.

Silent Shadows: Unveiling the Psoas Abscess and Its Treatment

Iliopsoas abscesses are a rare complication of appendicitis and are associated with high morbidity and mortality without appropriate intervention. Current literature provides sufficient evidence for managing psoas abscesses via antimicrobial therapy, CT-guided percutaneous drainage, and laparoscopic or open drainage as primary approaches. However, there is insufficient data in the current literature for assessing improved patient outcomes with robotically assisted laparoscopic drainage as an approach to treatment. Here, we present the case of a 72-year-old male with a prior history of perforated appendicitis complicated by a pelvic abscess and treated interventional radiology (IR)-guided drain, left partial nephrectomy secondary to renal cell carcinoma, and bilateral hip arthroplasty presenting with signs and symptoms of recurrent appendicitis. CT imaging found a loculated right iliopsoas abscess adjacent to the appendix, which was not amenable to IR percutaneous drainage. Surgical drainage was deemed necessary with a robotically assisted approach, and the patient had improved clinical status after the intervention. Early results show that robotically assisted laparoscopic surgery has been shown to shorten the clinical course for patients via decreased length of stay, faster recovery times, and better incisions cosmetically. Drainage via robotic laparoscopy allows for complete drainage and irrigation, maximizing source control of infection. It is an effective approach for the management of refractory psoas abscesses secondary to appendicitis.

Bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient: a case report

BACKGROUND

Worldwide, there is an increase in the frequency of reports of psoas abscesses due to advances in imaging technology, which has led to early diagnosis and treatment. A bilateral psoas abscess is rare and, when it occurs, is usually secondary and in immunocompromised patients. We present a case of a bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient.

CASE PRESENTATION

A 21-year-old Ugandan female undergraduate who contracted human immunodeficiency virus through vertical transmission and has been on highly active antiretroviral drugs presented with bilateral lower abdominal pain with associated fever and headache. Clinical examination revealed abdominal tenderness in both iliac fossae with palpable masses. Ultrasonography revealed fluid collection in both psoas muscles confirming bilateral abscesses. The aspirate was acid-fast bacilli positive. A diagnosis of bilateral tuberculosis psoas abscess was made. Open drainage was performed and antituberculosis drugs were commenced.

CONCLUSIONS

Bilateral tuberculosis psoas abscesses occurring in human immunodeficiency virus-positive patients, although uncommon, is not unexpected. It is a form of secondary psoas abscess in immunocompromised patients. Here, the outcome was successful with a combination of early surgical drainage and appropriate medical therapy.

A case report of iliopsoas abscess and literature review

RATIONALE

Iliopsoas abscess is a rare acute medical condition. It usually occurs because of the spread of infection from adjacent structures and hematogenous spread. Clinical features include fever, backache, radiating nerve root pain, and leg weakness. When sepsis occurs, prompt recognition is required to initiate appropriate antimicrobial therapy and surgical drainage.

PATIENT CONCERNS

A 65-year-old male presented to the outpatient department with a 2-day history of lower back, hip, and leg pain, for which analgesics were administered. During hospitalization, he experienced deterioration, becoming febrile, hypoxic, hypotensive, tachycardiac, and delirious.

INTERVENTIONS

The patient was then intubated and ventilated. His family reported an additional history of acupuncture for back pain, which sustained an inflamed wound on his right forearm. Abdominal computed tomography was performed, which confirmed bilateral iliopsoas abscess without involvement of intra-abdominal organs. A preliminary report of blood culture revealed Gram-positive cocci. Echocardiography showed vegetation on the aortic valve, and moderate aortic regurgitation was sustained. He was started on vancomycin along with piperacillin-tazobactam. Ultrasound-guided percutaneous drainage was inserted into the bilateral abscess. Pus and blood yielded methicillin-sensitive Staphylococcus aureus. He remained septic. The repeat computed tomography showed the right abscess enlarged. A repeated echocardiogram showed that the vegetation increased. Further incision and surgical drainage were performed with continuous wash-out.

OUTCOME

His condition improved after management and he was discharged to a regional hospital for ongoing care.

CONCLUSION

Prompt diagnosis and surgical treatment are essential to improve patient outcomes. The unique aspect of this case is the persistence of the methicillin-sensitive Staphylococcus aureus infection. Centralized surgical services are pivotal in conjunction with robust antimicrobial regimens.

LESSON

This case reinforces the importance of high clinical suspicion of an unknown source of sepsis.

"Iliacus muscle abscess as an unexpected cause of posterior hip pain in a healthy young adult female": a case report

BACKGROUND

Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of considering iliopsoas abscess in patients presenting with fever and hip pain, especially in the absence of obvious risk factors or penetrating trauma. The novelty of this case lies in its atypical presentation mimicking a respiratory viral infection and musculoskeletal injury, impeding accurate diagnosis and appropriate management.

CASE PRESENTATION

A previously healthy 21-year-old female who had a mechanical fall 3 weeks prior presented with fever, right hip pain, and respiratory symptoms, initially suggestive of a respiratory infection and musculoskeletal injury. However, initial investigations revealing a markedly high C-reactive protein (CRP) concentration prompted further computed tomography (CT) imaging of her abdomen and pelvis, which uncovered an iliopsoas abscess presumably stemming from antecedent trauma. Subsequent CT guided aspiration along with culture-sensitive antibiotics led to successful treatment and resolution of her symptoms.

CONCLUSIONS

This case emphasizes the importance of considering iliopsoas abscess as a possible differential, even in young patients without typical risk factors. Markedly elevated inflammatory markers such as CRP concentrations can serve as a vital indicator, directing attention towards the possibility of septicemia or the presence of an occult abscess, facilitating prompt imaging and accurate diagnosis.

Psoas abscess: an uncommon disorder

BACKGROUND

Psoas abscess (PA) is an uncommon disease that has been increasingly reported in the recent years. We reviewed patients with PA and analyzed their clinical characteristics to improve our understanding of this rare disorder.

METHODS

We retrospectively reviewed the clinical presentations, microbiology, and outcomes of patients with PA between 2011 and 2022 at the Zhejiang Provincial People's Hospital in China.

RESULTS

There were 40 adult patients identified with the discharge diagnosis of PA. The mean age was 60 years, and 67.5% of the patients were male. Primary symptoms were typically nonspecific. In all, 20 abscesses were considered secondary, and the most common was infective spondylitis. The most common causative organism for primary PA was Staphylococcus aureus, followed by Escherichia coli, whereas multiple bacterial species were found in secondary abscesses. The overall in-hospital mortality rate was 5%. Patients with secondary PA had a longer hospital stay.

CONCLUSION

PA, as a serious infectious condition, usually presents with nonspecific symptoms and laboratory test results, making early diagnosis difficult. These profiles differed from those reported in the present study. The initial clinical status and subsequent imaging studies can lead to favorable outcomes.

Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review

Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.

Psoas Abscess and Pott's Disease Masked by Concomitant Invasive Staphylococcus aureus Disease: A Case of Misleading Diagnosis

Psoas abscess is a rare infection classified as primary or secondary depending on the etiology of infection. Staphylococcus aureus is considered the most frequent causative agent. Nevertheless, psoas abscess persistent lack of improvement or any relapse after successful treatment should remind us to exclude other potential diagnoses. Although less frequently, Pott's disease is still one of the predisposing causes, especially in patients with immunocompromised status. This clinical condition has an indolent course and requires a high index of suspicion to avoid severe morbidity. Early recognition and targeted treatment are the principal means of ensuring tuberculosis control. Here we report a very interesting case of a psoas abscess and Pott's disease in a patient suffering from a misleading diagnosis of invasive staphylococcal disease.

Psoas and Mediastinal Abscesses during Intravenous Tocilizumab Treatment in Multicentric Castleman Disease

Tocilizumab has been used to treat idiopathic multicentric Castleman disease (iMCD). As tocilizumab prevents interleukin-6 from exerting pro-inflammatory effects, there is some concern about a delayed diagnosis of severe infections during tocilizumab treatment. Although serious infections during tocilizumab therapy have been previously described in patients with rheumatoid arthritis, they have not been reported in iMCD. We herein report a case of disseminated Staphylococcus aureus infection after a superficial skin wound followed by psoas and mediastinal abscesses with pyogenic spondylodiscitis in an iMCD patient with diabetes. Physicians should be alert for the occurrence of disseminated S. aureus infection after even minor skin injury during tocilizumab therapy.

Intestinal neuronal dysplasia presenting as psoas abscess: A case report

Background

Intestinal neuronal dysplasia (IND) is a rare condition mainly affecting the children. Constipation and abdominal distension have been reported as common manifestations. In addition, the reports about adult cases are scarce.

Case report

A 31-year-old man presented with pain in his left hip and intermittent fever for 1 month. The whole abdomen CT and pelvic contrast-enhanced MRI revealed a left psoas abscess (PA). The patient has been given anti-infective treatment and underwent CT-guided drainage of left PA with a temporary drain. But the patient's condition did not improve significantly. Then, the colonoscopy revealed that it may be the PA secondary to inflammatory bowel disease. But the pathology was not in line with inflammatory bowel disease. We finally performed an ileostomy surgery and took the whole layer of intestinal wall for biopsy. The pathological result revealed that a large number of proliferative ganglion cells and circuitous hyperplastic nerve fibers were found in the submucosa and muscular layer of the intestinal wall. Given pathological results and clinical manifestations, the patient was diagnosed with IND-B.

Conclusion

In this case, we first report an extremely rare case of adult IND manifesting as PA. So, this unusual case provides a new supplement to adult cases of IND.