Unusual Presentation of Recurrent Pyogenic Bilateral Psoas Abscess Causing Bilateral Pulmonary Embolism by Iliac Vein Compression

Abstract

Patient: Male, 47Final Diagnosis: Bilateral psoas abscess • acute lower extremity deep vein thrombosis • bilateral pulmonary embolismSymptoms: Progressive left leg swelling • productive cough with whitish sputum • right flank painMedication: Antibiotics and anticoagulationClinical Procedure: CT-guided percutaneous drain placementSpecialty: Internal Medicine/Critical CareObjective:Unusual presentationBackground:Psoas abscesses are a known cause of back pain, but they have not been reported as a cause of acute lower extremity thromboses and bilateral pulmonary emboli. We report a patient with bilateral psoas abscesses causing extensive pulmonary emboli through compression of the iliac vein.Case Report:A 47-year-old man presented with bilateral leg swelling over 4 weeks. Physical examination revealed a thin male with bilateral leg swelling, extending to the thigh on his left side. He had hemoglobin of 10.5 g/dl, leukocytosis of 16 000/ml, and an elevated D-dimer. A computed tomography (CT) angiogram of his chest showed extensive bilateral pulmonary emboli and infarcts. He remained febrile with vague flank pain, prompting a CT of his abdomen and pelvis that showed large, multiloculated, septated, bilateral psoas abscesses with compression of the left femoral vein by the left psoas abscess and a thrombus distal to the occlusion. Two liters of pus was drained from the left psoas abscess by CT-guidance, and although the Gram staining showed Gram-positive cocci in clusters, cultures from the abscess and blood were negative. A repeat CT showed resolution of the abscesses, and the drain was removed. He was discharged to a nursing home to complete a course of intravenous antibiotics and anticoagulation.Conclusions:Although the infectious complications of psoas abscesses have been described in the literature, the mechanical complications of bilateral psoas abscesses are lacking. It is important to assess for complete resolution of psoas abscesses through follow-up imaging to prevent venous thromboembolic events.

Clinical case report: discitis osteomyelitis complicated by inferior vena cava venous thrombosis and septic pulmonary emboli

“…Few cases of psoas abscess resulting in iliofemoral venous thrombosis have been reported [4], [5], [6], [7], [8]. We report a rare case of paraspinal abscess causing IVC thrombus, and the first as a result of viridans infection.…”

“…Psoas and paravertebral abscesses, as a complication of osteomyelitis, are frequently associated with Pott’s disease; however, pyogenic vertebral osteomyelitis can also result in formation of these abscesses [3]. Such intra-abdominal collections can in rare occasions cause compression of adjacent venous structures and result in deep vein thrombosis [4], [5], [6], [7], [8].…”

A Microbiologist’s Mexico Trip Ends with Multiple Tiny Ring-Like Pelvic Abscesses

“…Delay in diagnosis and treatment of iliopsoas abscess leads to multiple complications, including sepsis, septic arthritis, deep venous thrombosis, and ileus [16][17][18]. Advanced age, bacteremia, and delay in treatment are associated with increased mortality [8,17].…”

Comparison of the Anteroposterior and Posterior Approaches for Percutaneous Catheter Drainage of Tuberculous Psoas Abscess

“…Although cases of psoas abscess due to TB can present with a range of symptoms, this study has shown that most cases presented with few symptoms and required diagnosis using computed tomographic (CT) or magnetic resonance imaging (MRI). Recent studies have highlighted the infectious complications of psoas abscess, but also the possibility of complete resolution [ 16 ]. Imaging studies have now contributed to the development of treatment protocols for abscesses due to TB [ 17 , 18 ].…”