Pneumococcal psoas abscess: report of a case and review of the world literature

A 39-year-old man was admitted to the hospital with fever and right hip pain. CT scan of the pelvis showed a psoas muscle abscess. Pus, which was surgically evacuated, grew Streptococcus pneumoniae. The patient fully recovered after 30 days of intravenous antibiotics. Review of the literature revealed only nine similar cases of primary pneumococcal psoas abscess. Three cases were complicated with pneumococcal meningitis. In four cases there was a history of trauma to the involved area. Pneumococcal psoas abscess is a rare entity that carries a good prognosis provided early surgical drainage is performed and parenteral antibiotic therapy is administered to the patient.

Oral atovaquone compared with intravenous pentamidine for Pneumocystis carinii pneumonia in patients with AIDS. Atovaquone Study Group

OBJECTIVE

To test the hypothesis that the therapeutic success rate of oral atovaquone is not worse than that of intravenous pentamidine in the primary treatment of mild and moderate Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome and to detect differences in the toxicity rates of the two treatments.

DESIGN

Patients were randomly assigned to receive 21 days of open-label therapy with either atovaquone, 750 mg orally with meals three times daily, or intravenous pentamidine, 3 to 4 mg per kg body weight once daily.

SETTING

Multicenter study including university and community treatment facilities.

PATIENTS

Patients with human immunodeficiency virus infection and clinical presentations consistent with mild or moderate P. carinii pneumonia were eligible. For efficacy and safety analyses, patients with histologically confirmed P. carinii pneumonia were emphasized.

MEASUREMENTS

Patients were monitored by clinical and laboratory evaluations for therapeutic efficacy and adverse events during the acute treatment phase and for 8 weeks after therapy was discontinued.

RESULTS

As initial therapy for a histologically confirmed episode of P. carinii pneumonia, 56 patients received atovaquone and 53 received pentamidine. More patients were successfully treated with atovaquone (57%) than with pentamidine (40%), a difference of 17% (95% CI, -3% to 38%; P = 0.085), but more patients failed to respond to atovaquone (29%) than to pentamidine (17%), a difference of 12% (CI, -6% to 29%; P = 0.18). Discontinuation of original therapy because of treatment-limiting adverse events was more frequent in the pentamidine group (36%) than in the atovaquone group (4%) (difference, -32%; CI, -48% to -17%; P < 0.001). Nine patients in each treatment group died during the study.

CONCLUSIONS

Oral atovaquone and intravenous pentamidine have similar rates for successful treatment of mild and moderate P. carinii pneumonia, but atovaquone has significantly fewer treatment-limiting adverse events.

Staphylococcal meningitis: a complication of psoas abscess

A previously healthy 59-year-old woman presented with fever, neck stiffness, and localized back tenderness. Spinal fluid and blood cultures grew Staphylococcus aureus. A diagnosis of pyogenic meningitis was made, but further investigation revealed that the meningitis arose from a clinically occult psoas abscess.