Psoas abscess in chronic dialysis patients

Iliopsoas abscess in patients receiving hemodialysis: a case series and a literature survey

Background

Iliopsoas abscess is a relatively rare but serious infectious disease. Infectious disease is one of the major causes of death among patients receiving hemodialysis for end-stage renal disease (ESRD).

Case presentation

We experienced three cases of iliopsoas abscess in patients receiving hemodialysis. The infection route was distinct in each case. A 79-year-old woman with ESRD due to autosomal dominant polycystic kidney disease exhibited bilateral iliopsoas abscesses caused by bacterial contamination during a lumbar epidural block procedure. A 60-year-old woman with ESRD due to diabetic nephropathy was diagnosed as having an iliopsoas abscess, caused by the direct invasion of bacteria from a renal abscess. A 78-year-old woman who started hemodialysis because of nephrosclerosis developed an iliopsoas abscess caused by the hematogenous spread of bacteria from emphysematous cystitis. All three cases were treated with antibiotics and/or percutaneous drainage. A survey of published reports suggested that iliopsoas abscess can be caused by infection through a variety of routes in hemodialysis patients.

Conclusion

Because hemodialysis patients are at a high risk of infection because of their immunocompromised state, physicians should pay close attention to infection prevention. If iliopsoas abscess is suspected, examinations such as computed tomography, magnetic resonance imaging, and blood culture sampling should be conducted promptly, followed by appropriate treatment with antibiotics and/or drainage.

Iliopsoas abscess as a complication of tunneled jugular vein catheterization in a hemodialysis patient

Iliopsoas abscess is a rare complication in hemodialysis patients that is mainly due to adjacent catheterization, local acupuncture, discitis, and bacteremia. Herein, we report a 47-year-old woman undergoing regular hemodialysis via a catheter in the internal jugular vein who presented with low back pain and dyspnea. A heart murmur suggested the presence of catheter-related endocarditis, and this was confirmed by an echocardiogram and a blood culture of methicillin-resistant Staphylococcus aureus. A computed tomography indicated a pulmonary embolism and an incidental finding of iliopsoas abscess. Following surgical intervention and intravenous daptomycin, the patient experienced full recovery and a return to usual activities. This case indicates that an iliopsoas abscess can be related to a jugular vein catheter, which is apparently facilitated by infective endocarditis. The possibility of iliopsoas abscess should be considered when a hemodialysis patient presents with severe low back pain, even when there is no history of adjacent mechanical intervention.

Extra-renal abscess in chronic hemodialysis patients

AIM

Infectious disease represents one of the major causes of morbidity and mortality in hemodialysis patients. Extra-renal abscess constitutes a specific form of infection. The aim of this study was to evaluate and analyze the clinical characteristics of extra-renal abscess in chronic hemodialysis patients.

METHODS

We retrospectively studied the extra-renal abscess among chronic hemodialysis patients in Chang Gung Memorial Hospital at Kaohsiung, Taiwan. The records of 2,168 chronic hemodialysis patients from October 1986 to January 2000, were studied. The clinical features were reviewed and analyzed.

RESULTS

Sixteen patients who were enrolled during the study period developed extra-renal abscess. Ten of them were male. The mean age was 59.2 +/- 11.8 years old. More than half of the patients had diabetes (53.6%, 9/16). The locations of extra-renal abscess in these patients were liver (8/16), lung (5/16), spleen (1/16), perianal region (1/16), psoas muscle (1/16), and prostate (1/16). One patient had concurrent liver and spleen abscesses. All patients presented with fever and chills. Laboratory studies revealed leukocytosis and thrombocytopenia in 2/3 of the patients. The patients were associated with malnutrition status with lower serum albumin level (2.94 +/- 0.55 gm/dL) and lower nPCR (normalized protein catabolism rate; 0.84 +/- 0.11 gm/Kg/day) comparing to the other hemodialysis patients (albumin: 4.05 +/- 0.47 gm/dL; nPCR: 1.14 +/- 0.31gm/kg/day). There was no significant difference in kt/V between the patients with (1.28 +/- 0.34) or without abscess formation (1.47 +/- 0.36). The major causative pathogen was Klebsiella pnewnoniae. Parenteral antibiotic treatment is sufficient to treat most of the diseases, except 2 patients who needed surgical intervention. Twelve patients recovered after 2-3 weeks of treatment.

CONCLUSIONS

The study indicated that extra-renal abscess is rare in chronic hemodialysis patients. The abscesses occurred mostly in liver. Diabetes mellitus and poor nutrition status were the important predisposing factors. Gram-negative bacilli, K. pneumoniae, were the major pathogen. Most of the patients responded to parenteral antibiotics and surgical draining.

Penile arteries in humans. Origin--distribution--variations

The arterial supply to the penis remains unclear. The frequency of occurrence and functional significance of accessory pudendal arteries remains controversial and it has been suggested that the presence of variations is correlated with atheromatous disease involving internal pudendal arteries. We dissected pelvic and penile arteries in 20 adult fresh male cadavers. The results are expressed according to age and the presence of atherosclerosis. Three patterns of penile arterial supply can be described: type I arising exclusively from internal pudendal arteries (3/20), type II arising from both accessory and internal pudendal arteries (14/20) and type III arising exclusively from accessory pudendal arteries (3/20). This study emphasizes the findings previously reported by early anatomists. No correlation between the presence of accessory pudendal arteries and the extent of atheroclerosis was observed. Accordingly we postulate that these variations are usually congenital. Terminal branches of accessory pudendal arteries mainly supply the corpora cavernosa. As they are located very close to the prostate, the risk of injury is high during radical prostatectomy. The possibility of impotence from such injury after radical prostatectomy needs therefore to be reconsidered.

Pyogenic psoas abscess

In a 12-month period, five cases of pyogenic psoas abscess presented to the Townsville General Hospital. These cases are presented, together with a review of the literature to illustrate the clinical features of this condition and the therapeutic challenge it may pose.

Psoas abscess as a complication of subclavian venous catheterization

A 76 year old woman developed a psoas abscess from vascular seeding of an infected subclavian venous catheter. The presentation was insidious and diagnosis delayed. Despite adequate surgical drainage, the case proved to be fatal. Venous catheters should be regarded as a potential source of septicaemia and occult abscess formation.