A case report of an atypical presentation of pyogenic iliopsoas abscess

Abstract

BackgroundIliopsoas abscess is a collection of pus in the iliopsoas muscle compartment. It can be primary or secondary in origin. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site. This is commonly associated with a chronic immunocompromised state and tends to occur in children and young adults. Secondary iliopsoas abscess occurs as a result of the direct spread of infection to the psoas muscle from an adjacent structure, and this may be associated with trauma and instrumentation in the inguinal region, lumbar spine, or hip region. The incidence of iliopsoas abscess is rare and often the diagnosis is delayed because of non-specific presenting symptoms.Case presentationWe describe a patient with iliopsoas abscess who presented to the Emergency Department at X Hospital on three separate occasions with non-specific symptoms of thigh pain and fever before finally being admitted for treatment. This case illustrates how the diagnosis can be delayed due to its atypical presentation. Hence, highlighting the need for clinicians to have a high index of clinical suspicion for iliopsoas abscess in patients presenting with thigh pain and fever.ConclusionThe classic triad of fever, flank pain, and hip movement limitation is presented in only 30% of patients with iliopsoas abscess. Clinicians should consider iliopsoas abscess as a differential diagnosis in patients presenting with fever and thigh pain. The rare condition with the varied clinical presentation means that cross-sectional imaging should be considered early to reduce the risk of fulminant sepsis.

Development of an Iliacus Muscle Abscess after School Exercise in a 17-Year-Old Female Student

“…Although fever, flank pain, and limited hip movement are the classic triad of psoas abscess, initial symptoms may vary, as does the time required to develop the full triad of symptoms [16, 17]. In our patient, 9 days were required from initial exercise to a correct diagnosis of iliacus muscle abscess.…”

A case report of perinephric abscess extending as psoas abscess

“…The classical clinical triad consisting of fever, backache and limp is present on only 30% of the patients with iliopsoas abscess. 1,2 In one case report of pyogenic psoas abscess the patient had only non-specific leg pain. 2 Psoas abscess can also occur as an unusual complication, Al Shehri et al for example reported a case of late onset iliopsoas abscess due to stump appendicitis.…”

“…It is described as collection of pus in the iliopsoas compartment. 1,2 Bound anteriorly by the transversalis fascia, superiorly by endothoracic fascia and inferiorly by the fascia lata of the thigh, the iliopsoas compartment is an extraretroperitoneal space that runs along the posterior aspect of abdomen and pelvis and extends into the thigh.…”

“…Primary psoas abscess occurs most commonly in patients with history of diabetes, injection drug use, alcoholism, acquired immune-deficiency syndrome (AIDS), renal failure, haematological malignancy, immunosuppression or malnutrition. 1 Underlying gastrointestinal tract diseases, especially inflammatory bowel disease are the most common secondary cause of psoas abscess. There are only few cases of psoas abscess secondary to renal causes reported in literature.…”

Atypical Cause of Sepsis from Bilateral Iliopsoas Abscesses Seeded from Self-mutilation: A Case Report

“…6 There are cases in the literature of IPA presenting as exclusively fever and thigh pain. 1,7 If there is suspicion for an IPA, serum laboratory studies such as an elevated white blood cell count, ESR, or CRP, are non-specific, and diagnosis requires imaging. IPAs may be identified on ultrasound, CT, or MRI.…”