A Devasting Course of an Iliopsoas Muscle Abscess Subsequently Leading to Septic Shock, Septic Hip Arthritis, and Extended Gluteal Soft Tissue Necroses in an Elderly Immunocompromised Patient with Multiple Carcinomas: A Case Report and Brief Review of Literature

Abstract

Background:A devasting course of Iliopsoas Muscle (IPM) abscess remains a challenging therapeutic problem.Methods:A 69-year-old polymorbid male had a history of multiple carcinomas and presented with advanced stage of septic shock due to a right IPM abscess which communicated with the right hip joint and subsequently led to septic hip arthritis accompanied with post-infectious right gluteal deep soft tissue necroses. Management of surgical treatment included abscess revision, coverage with the use of Long Head Biceps Femoris Muscle (LHBFM) 180° turnover flap, and creating a Girdlestone resection-arthroplasty.Results:After a duration of patient's hospitalization of six months that included the necessity of artificial respiration over two months accompanied with in summary 18 required surgical procedures, the patient could be recovered successfully regarding his polymorbidity and his low-demand claims in activities of daily living with his Girdlestone resection-arthroplasty.Conclusion:Recovery of immunocompromised patients with those life-threatening situations can only be achieved by an interdisciplinary management. The LHBFM 180° turnover flap can be useful for filling off post-infectious deep soft tissue cavities communicating with the hip joint. The definitive Girdlestone resection-arthroplasty for treatment of septic hip arthritis is the method of choice for mobilization of elderly polymorbid patients with low demand claims in their activities of daily living.

Detection of mecA and 16S rRNA Genes Using Real-Time PCR Can Be Useful in Diagnosing Iliopsoas Abscess, Especially in Culture-Negative Cases: RT-PCR for Iliopsoas Abscess

“…Iliopsoas abscess is a relatively rare disorder that has a diversity of frequency depending on patients' race, gender, and preexisting diseases [1]. Sequential iliopsoas abscess has been reported in the immunological suppression in rheumatoid arthritis, cervical spondylosis infection, ulcerative colitis, malignant tumor cases, and cardiovascular disorders [22][23][24][25][26]. Our study demonstrated that undernutrition is an indicator for the possible presence of IPA; however, serum inflammatory markers may not be useful to differentiate IPA from other inflammatory responses.…”

Vascularized Muscle Flap to Reduce Wound Breakdown During Flexible Electrode-Mediated Functional Electrical Stimulation After Peripheral Nerve Injury

“…First, the present results cannot be directly extrapolated to humans. The procedure described here utilizing the BF muscle as a vascularized flap is unique to the anatomy of rats and currently there is no clear correlate in the anatomy of humans although the BF muscle turnover flap has been described for reconstruction of ischial pressure ulcers and abscesses (64,65). Second, the number of animals in this pilot study was small (n = 10) and, given the feasibility of this procedure demonstrated in this pilot study, a larger and longer-term follow-up study is necessary to validate the results described here.…”

Epidural phlegmon and iliopsoas abscess caused by Salmonella enterica bacteremia: A case report

“…The complications of IPA are severe, with septic shock occurring in up to 20 % of cases and a mortality rate ranging from 5 to 25 % [7] . In immunocompromised populations, the mortality rate can reach 100 % [7] . Given the severe nature of this disease, prompt treatment is critical.…”