Ruxolitinib associated psoas muscle tuberculosis abscess in a primary myelofibrosis woman: A case report and literature review

RATIONALE

Primary myelofibrosis is a subtype of myeloproliferative neoplasm that leads to bone marrow fibrosis. Historically, the only curative option for primary myelofibrosis was allogeneic hematopoietic stem cell transplant. Ruxolitinib, a Janus kinase inhibitor, is now used for the treatment of primary myelofibrosis and polycythemia vera. It effectively improves symptoms related to splenomegaly and anemia. However, its association with the development of opportunistic infections has been observed in clinical studies and practical application.

PATIENT CONCERNS

A 64-year-old female with primary myelofibrosis and chronic hepatitis B infection who received ruxolitinib treatment. She was admitted for spiking fever and altered consciousness.

DIAGNOSIS

Tuberculosis meningitis was suspected but cerebrospinal fluid can't identify any pathogens. An abdominal computed tomography scan revealed a left psoas abscess and an enlarged spleen. A computed tomography-guided pus drainage procedure was performed, showing a strong positive acid-fast stain and a positive Mycobacterium tuberculosis polymerase chain reaction result.

INTERVENTIONS

antituberculosis medications were administered. The patient developed a psoas muscle abscess caused by tuberculosis and multiple dermatomes of herpes zoster during antituberculosis treatment.

OUTCOMES

The patient was ultimately discharged after 6 weeks of treatment without apparent neurological sequelae.

LESSONS

This case underscores the importance of clinicians evaluating latent infections and ensuring full vaccination prior to initiating ruxolitinib-related treatment for primary myelofibrosis.

A comparative perspective on brucellar, pyogenic, and tuberculous spondylodiscitis

OBJECTIVE

Non-specific features of spondylodiscitis lead to a delay and challenge in the diagnosis/differential diagnosis/treatment processes, and thus, serious complications may arise. This study aims to compare brucellar, pyogenic, and tuberculous types of spondylodiscitis, considering their demographic, clinical, and laboratory differences. This may provide more rapid management and good outcomes.

PATIENTS AND METHODS

A total of 131 patients with infectious spondylodiscitis were included in the study. The patients were divided into brucellar (n=63), pyogenic (n=53), and tuberculous (n=15) types of spondylodiscitis and compared for demographic, clinical, laboratory, and imaging features.

RESULTS

Tuberculous spondylodiscitis had higher scores for weight loss, painless palpation, thoracic spine involvement, and psoas abscess formation than other spondylodiscitis. Also, tuberculous spondylodiscitis had higher rates of neurologic deficit and lower rates of lumbar involvement than brucellar spondylodiscitis. Pyogenic spondylodiscitis is more likely to occur in patients who have a history of spine surgery compared to other forms of spondylodiscitis. Also, pyogenic spondylodiscitis had higher rates of fever, erythema, paraspinal abscess, white blood cell (WBC), and erythrocyte sedimentation rate (ESR) than brucellar spondylodiscitis. On the other hand, brucellar spondylodiscitis had higher rates of rural living and sweating than pyogenic spondylodiscitis.

CONCLUSIONS

Weight loss, painless palpation, involved thoracic spine, psoas abscess, and neurologic deficit are symptoms favoring tuberculous spondylodiscitis. History of spine surgery, high fever, skin erythema, and paraspinal abscess are findings in favor of pyogenic spondylodiscitis. Rural living, sweating, and involved lumbar spine are symptoms that indicate brucellar spondylodiscitis. These symptoms can be used to distinguish the types of spondylodiscitis.

Endovascular Therapy of Aortic Rupture Secondary to a Psoas Abscess

Secondary infection of the aorta is a sporadic and life-threatening disease. It is usually caused by infection and abscess in an adjacent structure. The most common mechanism for secondary aortic infection is a psoas abscess eroding the aortic wall, which rarely results in non-aneurysmal aortic rupture. Primary treatment is surgical aortic reconstruction, but the risk of emergency surgical treatment is high. Endovascular aortic stent-graft implantation can be lifesaving in this setting by stopping the bleeding. However, the crucial question of durability and late infections remains unanswered and warrants long-term antibiotic treatment and follow-up. In this report, we present a case of primary psoas abscess, which resulted in non-aneurysmal aortic rupture and its endovascular treatment.

Recurrent Iliopsoas Abscesses Due to Migrated Appendicular Fecalith: A Case Report and Review of the Literature

CASE

Appendicular fecaliths have been reported to migrate to nearby organs before or during surgical treatment and become a late source of infection. We report an extremely rare case of recurrent iliopsoas abscesses caused by appendicular fecaliths that have migrated to the psoas muscle before or during the previous appendicectomy for acute appendicitis. In this case, surgical removal of fecaliths cured the iliopsoas abscess.

CONCLUSION

Orthopaedic surgeons and gastroenterologists should remember that appendicular fecaliths that migrated into the iliopsoas muscle may cause late-onset iliopsoas abscesses.

Treatment of Psoas abscess related coxarthrosıs due to salmonella infection in a patient wıth chronic renal failure. A case report

INTRODUCTION

The most common microorganisms isolated from septic arthritis are staphylococcus aureus and streptoccocci. Septic arthritis due to Salmonella spp. is extremely rare.

PRESENTATION OF CASE

A 55-year-old man, chronic renal failure, is admitted hip arthtritis with newly arised symptoms. The findings were not compatible with primary arthritis. The laboratory findings which include white blood cell count, erythrocyte sedimentation rate (esr) and c-reactive protein (crp) were elevated. In magnetic resonance (mr) imaging there were psoas abscess and septic arthritis of the hip. They were treated by drainage. The culture was confirmed as Salmonella spp. Antibiotic treatment were done.

DISCUSSION

Uremia in patients with chronic renal failure is associated with a state of immune dysfunction. In our case, uremia may cause immunosuppressive conditions and hematogenous dissemination of salmonella.

CONCLUSION

Salmonella infection in a patient with chronic renal failure may be occured. It must be kept in mind that early diagnosis, administration of appropriate systemic antibiotics and surgical intervention play a pivotal role in successful management.

KEY WORDS

Arthritis, Failure, Psoas, Salmonella Renal Abscess.

Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study

BACKGROUND

Iliopsoas abscess (IPA) is a rare clinical entity and is difficult to diagnose due to its insidious onset and nonspecific symptoms. The association between IPA and cardiovascular disorders (CVD) has been rarely reported. Computed tomographic (CT) scan can provide a definitive diagnosis of IPA and associated foci of adjacent structures. IPA is a life-threatening condition, especially when associated with CVD.

MATERIALS AND METHODS

We conducted a hospital-based observational study of IPA associated with CVD. Data were collected from the electronic clinical database of Taichung Veterans General Hospital (1520-bed tertiary referral hospital in central Taiwan) between July 2007 and December 2017. The diagnosis of IPA associated with CVD was confirmed by classical findings on CT and transesophageal echocardiography with compatible clinical presentation and cultures from pus/tissue and blood.

RESULTS

Fifteen patients of IPA associated with CVD were studied. They included 12 males (80%) and 3 females (20%), with a mean age 63.2 ± 16.9 years (31-85 years). CVD included stent-graft/endograft infection of abdominal aortic aneurysm (AAA) (40%), primary mycotic AAA (33.3%), and infective endocarditis (26.7%). Staphylococcus aureus is the most common microorganism in pus/tissue cultures (n = 3, 37.5%) and in blood cultures (n = 6, 40%). The average length of hospital stay was 33.1 ± 20.5 days (range, 3-81 days; median, 33 days). Hospital stay lasted 42.6 ± 19.2 days in the survival group and 19.0 ± 14.1 days (P = 0.018) in the non-survival group. Incidence of patients staying in the intensive care unit (ICU) with intubation > 3 days was 33% in the survival group and 100% (P = 0.028) in the non-survival group. Intra-hospital mortality rate was 40%. Poor prognostic factors in the non-survival group were hypoalbuminemia, hyponatremia, involved disc/vertebral body and/or epidural abscess, and ICU stay with intubation > 3 days. Cumulative survival rate was 25% under conservative treatments and 66.3% under aggressive treatments (P = 0.038).

CONCLUSION

Due to high mortality rates, clinicians should keep a high suspicion index for IPA associated with CVD through clinical presentation, physical examination, and imaging study. Timely empiric antibiotics for common bacteria, drainage for IPA, endovascular repair, or vascular reconstruction by graft replacement or bypass with intensive care should be mandatory to shorten the hospital stay, reduce medical costs, and lower mortality rate.

Primary iliopsoas abscess combined with rapid development of septic shock: Three case reports

RATIONALE

Primary iliopsoas abscess (IPA), an uncommon clinical entity, often has no specific clinical features, and advanced imaging techniques are often required for diagnosis.

PATIENT CONCERNS

We successfully treated 3 patients with primary IPA complicated by rapid development of septic shock within 2 months.

DIAGNOSIS

All patients were in shock at the time of admission and were diagnosed with primary IPA by history, clinical examination and imaging findings.

INTERVENTIONS

All patients were treated by surgical drainage and sensitive antibiotics based on culture results.

OUTCOMES

The patients eventually recovered and were discharged within 2 months.

LESSONS

An IPA may not be diagnosed in a timely manner because it has no specific symptoms or signs. Therefore, special attention must be given to patients with sudden onset of abdominal pain, hip pain, or high fever without an obvious cause, a primary IPA should be highly suspected in such patients.

Pneumothorax Secondary to Septic Pulmonary Emboli in a Long-term Hemodialysis Patient with Psoas Abscess

Pneumothorax secondary to septic pulmonary embolism (SPE) is rare but life-threatening. We herein report a long-term hemodialysis patient with psoas abscess caused by methicillin-resistant Staphylococcus aureus, associated with other muscle and splenic abscesses and SPE. Intravenous vancomycin treatment and percutaneous drainage of the psoas abscess rapidly improved her condition. However, the SPE lesions continued to increase, and right-sided pneumothorax occurred 10 days after treatment. The pneumothorax resolved after two months and SPE and all abscesses after four months of treatment. Since late-onset pneumothorax caused by SPE can occur despite successful treatment of the primary infection, care should be taken with such patients.

Necrotising fasciitis caused by metastatic endometrial cancer: a rare cause of a life-threatening condition

We report a case of necrotising fasciitis caused by metastatic endometrial adenocarcinoma. Metastases to the lumbar spine with local invasion to the iliopsoas muscle led to an iliopsoas abscess, which subsequently progressed to necrotising fasciitis of the flank. This patient lacked common risk factors for necrotising fasciitis. There are no previous reports in the literature of necrotising fasciitis with this aetiology. We discuss the available evidence for aetiology of and risk factors for necrotising fasciitis, and the relation of time to surgery with prognosis.

Acute transverse myelitis of the cervical spine secondary to psoas abscess

BACKGROUND

Acute transverse myelitis is uncommon and presumably results from an autoimmune process or a preceding infection. Most cases of bacterial myelitis are due to hematogenous dissemination from urinary or respiratory tract infections or contiguous spreading from a neighboring infected structure. A psoas abscess rarely spreads to higher levels of the spinal cord. No cases of acute cervical myelitis due to a psoas abscess have been previously reported.

CASE PRESENTATION

A 34-year-old man was transferred to our hospital due to progressive muscle weakness, sensory deficits and severe hypotension. Two weeks prior to admission, he had received low back injection to relieve back pain in a healthcare clinic. One day prior to admission, his condition had worsened. On admission, he was tetraplegic with absence of sensation below the level of the suprasternal fossa. A lumbar CT scan demonstrated an abscess in the left psoas, and the magnetic resonance imaging (MRI) scan of the entire spinal suggested a cervical spine infection. A cerebrospinal fluid (CSF) analysis performed before surgery indicated the possibility of bacterial infection. An operation was performed to drain the abscess. Microbiological cultivation revealed a Methicillin-resistant Staphylococcus aureus (MRSA) infection. The patient was administered with vancomycin for 10 days and followed by oral formulations of linezolid for 6 weeks. The patient's general condition improved, and he was successfully discharged. Six months later, a follow-up MRI revealed that the lesion of the cervical spine had been ameliorated, and the sensation and myodynamia of his upper limbs had partially recovered.

CONCLUSION

This was a rare case of a high-level cervical spine pyogenic infection complicating psoas abscess. An invasive paravertebral injection procedure was thought to be the initial damaging event that created a port of entry for MRSA into the psoas muscle and caused a subsequent psoas abscess. This case indicated that evaluation of higher levels of the spine is warranted when a psoas abscess coexists with severe weakness.

Bilateral Portal Percutaneous Endoscopic Debridement and Lavage for Lumbar Pyogenic Spondylitis

Common management approaches for spinal infections include conservative administration of antibiotics and aggressive surgical debridement. Minimally invasive endoscopic treatment has been reported and is gaining widespread attention because of its simplicity and effectiveness. This study retrospectively evaluated the clinical outcomes of bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution in the treatment of patients with lumbar pyogenic spondylitis. From January 2007 to December 2011, a total of 22 patients diagnosed with single-level lumbar pyogenic spondylitis underwent bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution at the authors' institution. Clinical outcomes were assessed by careful physical examination, visual analog scale pain score, modified MacNab criteria functional score, regular serologic testing, and imaging studies to determine whether percutaneous endoscopic debridement and lavage treatment was successful or if surgical intervention was required. Causative bacteria were identified in 19 (86.4%) of 22 biopsy specimens. Eighteen patients had satisfactory relief of back pain and uneventful recovery after this treatment. The success rate was 81.8% (18 of 22). Both visual analog scale and modified MacNab criteria scores improved significantly in successfully treated patients. No major surgical complications were noted, except for 3 patients who had residual or subsequent paresthesia in the affected lumbar segment. Percutaneous endoscopic debridement and lavage is a minimally invasive procedure that can yield a higher bacterial diagnosis, relieve back pain, and help to eradicate lumbar pyogenic spondylitis. It is an effective alternative treatment for patients with spinal infection before extensive open surgery.

RS3PE Syndrome with Iliopsoas Bursitis Distinguished from an Iliopsoas Abscess Using a CT-guided Puncture

A 55-year-old man was diagnosed with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Contrast-enhanced computed tomography for cancer screening showed a mass with low-density centers with an enhanced rim in the left iliopsoas muscle. We suspected an iliopsoas abscess and performed computed-tomography-guided puncture of the mass. Both Gram staining and the culture of the fluid were negative. We diagnosed the patient with RS3PE syndrome with iliopsoas bursitis and administered low-dose corticosteroids without antibiotics. The symptoms, including left hip pain, quickly disappeared following treatment. Clinicians should be aware that iliopsoas bursitis may resemble an iliopsoas abscess. As a result, it is important to make an accurate differential diagnosis.

Bilateral iliopsoas abscess associated with right hip septic arthritis in a neonate

Iliopsoas abscess is a very rare pathology in the neonatal period. There is a lack of reports in the literature on bilateral psoas abscess with hip joint arthritis. We report a case of bilateral iliopsoas abscess with concomitant right hip septic arthritis, caused by methicillin-resistant Staphylococcus aureus in a 28-day-old male infant. The baby presented with bilateral diffuse swelling of the groins and upper thighs. He was treated successfully by ultrasound-guided percutaneous drainage along with systemic antibiotic therapy. Clinical improvement was observed within 24-48 hours of drainage.

Psoas abscess with septic arthritis of the hip: a case report

Psoas abscess associated with septic arthritis of the hip is unusual in infants. A 12-month-old infant presented with the complaints of fever, left hip pain and limp. Magnetic resonance imaging revealed left psoas abscess accompanied by septic arthritis of the hip. In this report, we present a case of psoas abscess with hip septic arthritis in an infant, and we describe the clinical and radiological findings and treatment of this case.

[Psoas abscess as a differential diagnosis in emergency department]

BACKGROUND

A psoas (or iliopsoas) abscess is a rare clinical entity with a wide etiological range. It is defined as a collection of pus that begins and extends through the iliopsoas muscle and can reach up to the inguinal region.

METHODS

We performed a retrospective descriptive study by reviewing medical records from the General Surgery department of Reina Sofía's General University Hospital. Information was collected from patients diagnosed with psoas abscess who were admitted to the General Surgery department from 2006 to 2011.

RESULTS

Five cases were reported for 6 years: four males (80%) and one female (20%). Average age was 51.6 years (range: 35--75). All were admitted to the hospital through the Emergency Department. Lumbar pain, fever and rash were clinical features in three patients. Two patients initiated with septic shock. Each patient had computed tomography performed, which confirmed the diagnosis. Causes of the abscess were as follows: one perforated colon neoplasm, two left hip osteomyelitis, one Crohn's disease and one primary abscess. Surgery was the treatment in three cases and placement of pigtail drainage was the treatment in two patients. Two patients were admitted to the Intensive Care Unit and ultimately died.

CONCLUSION

In our case series report, it is seen that treatment delay developed to septic shock and death. We should consider this entity in emergency practice in order to carry out timely treatment.

Hip pain and cauda equina syndrome

Acute cauda equina syndrome secondary to a spinal epidural abscess as a result of a psoas abscess is very uncommon. We report the case of a 64-year old with a 6-day history of left hip pain, which progressively worsened until she presented to the emergency department with systemic infective symptoms and classical acute cauda equina syndrome. A good clinical outcome was achieved by urgent posterior decompression, followed by CT-guided drainage of the psoas abscess and appropriate antibiotic treatment.

Successful treatment of chronic intractable itching using oral pregabalin in a patient with diabetes and systemic prurigo nodularis: a case report of an iliopsoas muscle abscess

A 73-year-old Japanese man developed chronic intractable itching due to prurigo nodularis. High-dose glucocorticoid ointment failed, and the treatment resulted in poor glycemic control. Repeated scratching caused hematogenous bacterial dissemination via cutaneous injuries, resulting in the formation of iliopsoas and spinal epidural abscesses that required long-term antibiotic treatment. Pregabalin was administered to treat the pruritus, and a considerable improvement was observed. A reduction in the dose and intensity of the topical corticosteroids improved the patient's glycemic control, resulting in the complete resolution of the abscesses. Pregabalin significantly improved the patient's pruritus and decreased the risk of infection.

Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis--a case report

Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.

Iliopsoas tuberculous abscess associated with cervical and axillary tuberculous lymphadenopathy

The authors report a case of iliopsoas tuberculous abscess without obvious spinal column involvement. Cervical and axillary tuberculous lymphadenopathy were also presented. Despite appropriate antituberculous treatment, patient required percutaneous drainage with CT-guided catheter insertion.

Pneumococcal vertebral osteomyelitis and psoas abscess in a patient with systemic lupus erythematosus disclosing positivity of pneumococcal urinary antigen assay

A 53-year-old woman with systemic lupus erythematosus presented with a 3-day history of fever and coughing. Diagnosis of pneumococcal bronchitis was made based on symptoms and positivity of pneumococcal urinary antigen test. On day 3, severe low back pain acutely occurred. Pneumococcal vertebral osteomyelitis and psoas abscess was diagnosed 17 days later by yield of penicillin-susceptible S. pneumoniae strain in blood cultures and drainage fluid. Although pneumococcal urinary antigen test is a useful tool for the diagnosis of pneumococcal pneumonia, we should consider the possibility of pneumococcal infections other than pneumonia or overwhelming bacteremia in immunosuppressive patients when urinary antigen test is positive.

Psoas abscess with associated septic arthritis of the hip in infants

We describe psoas abscess with concomitant septic hip arthritis in 2 infants, 3 and 7 months old. The common clinical features were a palpable mass in the inguinal region, irritable hip, and delayed treatment. The diagnosis of septic hip was delayed in one child, and they both had residual hip deformity at follow-up. It is possible that initial delay in diagnoses resulted in the concurrent pathologic condition because of spread of infection. These 2 cases demonstrate the first known reports of concurrent psoas abscess and septic hip arthritis in infancy. Magnetic resonance imaging is a valuable method to identify these concurrent pathologic conditions. A proposed etiologic mechanism is also discussed in the article.

Septicemia of unknown origin causing by Streptococcus agalactiae primary psoas abscess: a case report

Staphylococcus aureus is the commonest organism resulting in primary psoas abscesses. However non-staphylococcal primary psoas abscesses have increasingly been published in the literature. Here, the author reports a case of primary psoas abscess in a type II diabetic woman previously diagnosed Streptococcus agalactiae septicemia of unknown origin, which rapidly responded to penicillin plus clindamycin and prompt surgical drainage. Diabetic patients are not only susceptible to soft tissue infection but also primary psoas abscess caused by Streptococcus agalactiae.

Non-contiguous multifocal Staphylococcus aureus discitis: involvement of the cervical, thoracic and lumbar spine

INTRODUCTION

Multilevel discitis is rare, and classically due to granulomatous organisms like Mycobacterium tuberculosis, brucella and fungal species.

CONCLUSION

We report a case of non-contiguous multilevel synchronous bacterial discitis involving cervical, thoracic and lumbar discs, attributable to Staphylococcus aureus.

A case of afebrile miliary tuberculosis that progressed from tuberculous spondylitis with iliopsoas abscess

We present a case of a 78-year-old woman who visited our hospital for chronic atrial fibrillation. She consulted an orthopedic surgeon for lumbar pain in August 2009 and has been followed up for osteoporosis. However, her lumbar pain became exacerbated. In December 2009, clinical examination revealed that the pain was caused by tuberculous spondylitis and iliopsoas abscess. Diffuse miliary shadow, which was undetected earlier, was noted on chest roentgenogram; she was diagnosed with miliary tuberculosis. Lumbar pain is common in elderly individuals and should be regarded as one of the tuberculosis symptoms, considering its atypical course in elderly patients.

A case of primary psoas abscess presenting as buttock abscess

Buttock abscess is a rare clinical manifestation from unusual extrapelvic extension of psoas abscess. A 48-year-old woman presented with painful swelling of the buttock with a sense of local heat. Magnetic resonance imaging revealed a large subfascial abscess over the glutei muscles and was traced into the intraabdominal cavity over the iliac wing to the psoas muscle. Both the psoas abscess and the buttock abscess were evacuated via separate approaches. Empirical antibiotic therapy was delivered for 3 weeks. After 6 months, no evidence of recurrence was found. Psoas abscess could be included in the differential diagnosis of buttock abscess.

Group C streptococcal psoas abscess associated with a homolateral hip joint prosthesis infection: a case report

An abscess in the psoas muscle is rare and frequently misdiagnosed. A delay in the diagnosis can increase its mortality rate. Some clinical signs can help the clinician but they all are not always present, and not at the same time. We describe in this paper a case report of an association between a psoas abscess and a homolateral hip joint prosthesis infection. It was suspected because of no improvement in clinical state despite treatment of the abscess by antibiotics and drainage, and it required finally other complementary therapeutic solutions. The pathogenic microorganism was a group C streptococcus. We discuss all these points and thereafter we suggest some recommendations for the clinician.

Fever, pain, and a limp: a case of a psoas and spinal epidural abscess caused by methicillin-resistant Staphylococcus aureus in a diabetic patient

Psoas and spinal epidural abscesses are rare conditions that are infrequently found occurring simultaneously in the same patient. This case presents an 18-year-old female with diabetes mellitus who presented with fever and leg pain. Blood and urine cultures were positive for methicillin-resistant Staphylococcus aureus. A CT scan of the abdomen showed a large psoas abscess with loculations extending and involving the spinal canal. The abscesses were drained and the patient completed a 6-week course of intravenous antibiotics with remarkable improvement of her clinical condition. The diagnosis of psoas and epidural abscesses is difficult and can be overlooked or delayed as a result of their vague clinical manifestations and their rarity, which leads to a lack of clinical suspicion.

Rupture of a nonaneurysmal abdominal aorta due to spondylitis

Contiguous arterial infections are extremely rare, and their actual rate of occurrence is not known. These infections occur as a result of direct invasion of an artery from an adjacent septic focus. Reaching the diagnosis of infected aorta is very difficult when there are contiguous infections from spondylitis or psoas abscess, because the clinical features are nonspecific. Although computed tomography is the most useful diagnostic tool in the detection of aortic infections, the most frequent findings mimic those of other diseases, such as retroperitoneal fibrosis, lymphoma, and periaortic lymphadenopathy. Diagnosis becomes even more challenging when an infected aorta is of normal diameter. Herein, we report the case of a 64-year-old man who experienced nonaneurysmal abdominal aortic rupture due to spondylitis and psoas abscess. Despite appropriate surgical management, the patient later died. We review the relevant medical literature and examine specific considerations that surround the diagnosis and treatment of this rare condition.

[Retroperitoneal abscess by suppurative psoas. Case report]

A 51 years old male was admitted to our Emergency Department because a severe pain in the right lumbar area irradiating to homolateral thigh, with fever. Abdomen and pelvis TC scan revealed a big retroperitoneal abscess. An urgent laparotomy was performed. It showed a huge retroperitoneal purulent collection extending caudally to right thigh and all around urinary bladder. The fluid collections were drained and a sample was sent for biological examination. There was the evidence of enterococcus faecalis and specific antibiotic treatment was done. The patient was discharged after 33 days in good general conditions. The aim of this study is to emphasize the difficulty in clinical diagnosis of this pathology due to the lack specific symptoms and signs, and the occasional difficulty to find the original cause of the condition. Moreover we remark the utility of CT scan and of selective collection drainage.

Aeromonas hydrophila bacteraemia and portal pyaemia

The Aeromonas species uncommonly cause disease in humans. We report portal pyaemia secondary to Aeromonas hydrophila bacteraemia occurring in a 71-year-old Chinese man with no history of hepatobiliary disease or malignancy. He presented with fever, rigors and abdominal bloating for four days and was subsequently found to have Aeromonas hydrophila bacteraemia, portal vein thrombosis and a psoas abscess. He was treated with ciprofloxacin and had a good recovery. Aeromonas hydrophila infection is an uncommon cause of intestinal and extraintestinal infection in man, but must be suspected in immunocompromised hosts and in those exposed to brackish or salt water.

Xanthgranulomatous pyelonephritis associated with Staphylococcus aureus

A 44-year old man with xanthogranulomatous pyelonephritis presented with abdominal distention, left lumber pain, fever, loss of appetite, and loss of weight. He had been known to have diabetes mellitus type II for 20 years, and he was diagnosed to have a left renal stone three months prior to this presentation. The patient's urine and the left psous abscess grew staphylococcus aureus.

Diffuse xanthogranulomatous pyelonephritis with psoas abscess in a pregnant woman

We report the first case, to our knowledge, of xanthogranulomatous pyelonephritis (XGP) with psoas abscess occurring during pregnancy. A 37-year-old woman in the third trimester of pregnancy presented with low back pain and a fever. From sonographic features, a multidisciplinary team decided to perform computed tomography of the abdomen with contrast agent injection, which strongly suggested diffuse XGP of the left kidney with a psoas abscess. Cesarean section at 32 weeks was followed by extended nephrectomy. Pathological examination of the operative specimen confirmed the diagnosis. Outcomes were favorable in the mother and baby. The diagnosis and treatment of XGP during pregnancy are discussed.

[The cold tuberculous abscess. A forgotten entity? Considerations based on an autopsy case]

We present the clinical case of a 28-year old male with pulmonary and extrapulmonary tuberculosis in absence of HIV infection; who also presented a left iliac psoas abscess of torpid evolution simulating an strangulated hernia and died of a sepsis due to colonic perforations by anaerobics and E. histolytica.

MATERIAL AND METHODS

Histological sections of the autopsy were studied with hematoxilin-eosin, Gram and Ziehl-Neelsen stains.

RESULTS

Autopsy study showed bilateral cavitated tuberculosis, Pott disease of thoracic spine and a cold tuberculous abscess on both psoas muscle and the lower third of the left thigh. Descending colonic perforation were identified, the responsible microorganism were Staphylococcus albus, Klebsiella sp, and E. coli.