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Huang CW, Yeo MYW. "Iliacus muscle abscess as an unexpected cause of posterior hip pain in a healthy young adult female": a case report. Int J Emerg Med 2024; 17:92. [PMID: 39020267 PMCID: PMC11253457 DOI: 10.1186/s12245-024-00668-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/05/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of considering iliopsoas abscess in patients presenting with fever and hip pain, especially in the absence of obvious risk factors or penetrating trauma. The novelty of this case lies in its atypical presentation mimicking a respiratory viral infection and musculoskeletal injury, impeding accurate diagnosis and appropriate management. CASE PRESENTATION A previously healthy 21-year-old female who had a mechanical fall 3 weeks prior presented with fever, right hip pain, and respiratory symptoms, initially suggestive of a respiratory infection and musculoskeletal injury. However, initial investigations revealing a markedly high C-reactive protein (CRP) concentration prompted further computed tomography (CT) imaging of her abdomen and pelvis, which uncovered an iliopsoas abscess presumably stemming from antecedent trauma. Subsequent CT guided aspiration along with culture-sensitive antibiotics led to successful treatment and resolution of her symptoms. CONCLUSIONS This case emphasizes the importance of considering iliopsoas abscess as a possible differential, even in young patients without typical risk factors. Markedly elevated inflammatory markers such as CRP concentrations can serve as a vital indicator, directing attention towards the possibility of septicemia or the presence of an occult abscess, facilitating prompt imaging and accurate diagnosis.
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Affiliation(s)
- Caleb Weihao Huang
- Acute & Emergency Care, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore.
| | - Mathew Yi Wen Yeo
- Acute & Emergency Care, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
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Mougui A, El Bouchti I. Primary psoas abscess as a complication of postpartum: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241260184. [PMID: 38854677 PMCID: PMC11159545 DOI: 10.1177/2050313x241260184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/22/2024] [Indexed: 06/11/2024] Open
Abstract
Primary psoas abscess is an uncommon yet critical factor contributing to postpartum sepsis. This report is of a case of postpartum primary psoas abscess in a 24-year-old Moroccan woman. After an uncomplicated vaginal delivery, a 24-year-old primiparous Moroccan woman presented to our hospital with a 3-week history of severe left-sided lower abdominal pain that radiated to the anterior aspect of the left thigh. She had been taking ciprofloxacin, metronidazole, and paracetamol for a week without any improvement. On examination, she was febrile and pale. The laboratory analysis revealed the presence of microcytic anemia, an elevated erythrocyte sedimentation rate, and an increased level of C-reactive protein. Computed tomography scans of the abdomen, and pelvis were conducted, revealing a substantial left psoas abscess. Under the guidance of computed tomography, anterior abdominal percutaneous drainage of the abscess was successfully performed. A pan-sensitive Streptococcus agalactiae strain was identified through culture of the specimen. The patient showed a favorable response to treatment with amoxicillin/clavulanate and gentamicin. This case illustrates that primary psoas abscess should be considered in cases of any postpartum infectious presentation.
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Affiliation(s)
- Ahmed Mougui
- Department of Rheumatology, Mohammed VI University Hospital, Marrakech, Morocco
| | - Imane El Bouchti
- Department of Rheumatology, Mohammed VI University Hospital, Marrakech, Morocco
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Jiang K, Zhang W, Fu G, Cui G, Li X, Ren S, Fu T, Geng L. Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review. Front Surg 2022; 9:871292. [PMID: 35832495 PMCID: PMC9271797 DOI: 10.3389/fsurg.2022.871292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionIliopsoas abscess with septicemia in the pediatric population is rare. Early diagnosis and effective management of this emergent disorder remain challenging for clinicians.Case PresentationA 14-year-old girl presented with right lateral and posterior hip pain and fever for 7 days before admission. Blood culture was positive for Staphylococcus aureus. Enhanced magnetic resonance imaging revealed abscesses located in the right iliopsoas muscle and on the surface deep to the fascia of the right sacroiliac joint that were 6.8 cm × 6.2 cm × 5.7 cm and 3.7 cm × 3.5 cm × 2.1 cm, respectively. A diagnosis of right iliopsoas abscesses with septicemia was made. The patient received intravenous antibiotics, underwent ultrasound-guided percutaneous catheter drainage, and recovered uneventfully. Medical literature regarding this issue published in the English language during the last two decades was reviewed.DiscussionPrimary synchronous psoas and iliacus muscle abscesses are rare and emergent disorders in the pediatric age group. The diagnosis is generally delayed owing to the deep anatomic location and nonspecific signs and symptoms. A comprehensive medical history, meticulous physical examination, and judicious use of imaging studies could establish a timely and accurate diagnosis. Surgeons should be aware of the occurrence of multiple abscesses. Prompt and adequate antibiotic therapy accompanied by a mini-invasive approach, such as ultrasound-guided, laparoscopic, or video-retroperitoneoscopic drainage of the infectious focus, if indicated and feasible, is important to achieve a good outcome in the management of iliopsoas abscess.
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Affiliation(s)
- Kun Jiang
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Wenxiao Zhang
- Department of Ultrasonic Medicine, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Guoyong Fu
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Guanghe Cui
- Department of Ultrasonic Medicine, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Xuna Li
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Shousong Ren
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
- Correspondence: Tingliang Fu Lei Geng
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
- Correspondence: Tingliang Fu Lei Geng
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Komarova EA, Lipatov KV, Shevchuk AS. [Purulent iliopsoitis: etiology, pathogenesis, diagnosis and surgical treatment]. Khirurgiia (Mosk) 2021:87-91. [PMID: 34608785 DOI: 10.17116/hirurgia202110187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purulent iliopsoitis is a quite rare and difficult disease regarding diagnosis and treatment. However, treatment outcomes are not so favorable, incidence of sepsis and mortality are still extremely high. Original up-to-date studies devoted to this issue were analyzed. The authors discuss the actual problems of etiology, pathogenesis, classification, clinical features, diagnosis and surgical treatment of iliopsoitis. Considering these data, they conclude that timely diagnosis and adequate surgical treatment are essential for favorable outcomes. Prevention of relapse is based on detection of possible cause of disease and its possible correction.
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Affiliation(s)
- E A Komarova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K V Lipatov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A S Shevchuk
- Sechenov First Moscow State Medical University, Moscow, Russia
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Acute Flaccid Paralysis in a Child: It Is Not Guillain-Barré Syndrome Always! Indian Pediatr 2021. [PMID: 33452794 PMCID: PMC7840384 DOI: 10.1007/s13312-021-2115-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chebli LA, Gaburri PD, Chebli JMF. Limp and Fever Leading to a Surprising Diagnosis. Am J Med 2019; 132:704-705. [PMID: 30831064 DOI: 10.1016/j.amjmed.2019.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Liliana Andrade Chebli
- Department of Internal Medicine, University Hospital of the Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Pedro Duarte Gaburri
- Department of Internal Medicine, University Hospital of the Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Julio Maria Fonseca Chebli
- Department of Internal Medicine, University Hospital of the Federal University of Juiz de Fora, Minas Gerais, Brazil.
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Simonin A, Paris O, Brouland JP, Morard M, San Millán D. Degenerative Disc Disease Mimicking Spondylodiscitis with Bilateral Psoas Abscesses. World Neurosurg 2018; 120:43-46. [PMID: 30149157 DOI: 10.1016/j.wneu.2018.08.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sequestered disc fragments may present as a lesion with peripheral enhancement on magnetic resonance imaging. When located in the psoas muscle compartment, this finding could mimic an abscess. CASE DESCRIPTION We describe a case of a 52-year-old man who returned from Togo after 2 years of living in precarious conditions. He was afebrile and complaining of lumbar back pain. The magnetic resonance imaging showed L3 and L4 vertebral body enhancement with bilateral psoas lesions in continuity with the disc space, suggesting spondylodiscitis with a differential diagnosis of inflammatory herniated disc. A computed tomography-guided biopsy of the right psoas lesion was performed to rule out spondylodiscitis. Histology was compatible with extruded disc material. CONCLUSION Herniated disc fragments should be considered as a differential diagnosis of psoas abscesses. Coronal plane images may show the continuity of bilateral herniated disc fragments, mimicking psoas abscesses.
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Affiliation(s)
- Alexandre Simonin
- Neurosurgery, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Olivia Paris
- Internal Medicine, Hôpital de Sion, Centre Hospitalier Universitaire Vaudois, Sion, Switzerland
| | - Jean-Philippe Brouland
- University Pathology Iinstitute, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marc Morard
- Neurosurgery, Hôpital de Sion, Centre Hospitalier Universitaire Vaudois, Sion, Switzerland
| | - Diego San Millán
- Neuroradiology, Service of Diagnostic and Interventional Radiology, Hôpital de Sion, Centre Hospitalier Universitaire Vaudois, Sion, Switzerland
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García-Morán A, Campoamor-Serrano MT, de la Fuente-García B, Viejo-Guerra G, Fernández-Regueiro R. [Psoas abscess secondary to perforated acute diverticulitis]. Semergen 2017; 43:407-409. [PMID: 28434808 DOI: 10.1016/j.semerg.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/12/2016] [Accepted: 11/18/2016] [Indexed: 11/26/2022]
Affiliation(s)
- A García-Morán
- Servicio de Medicina Interna, Hospital de Cabueñes, Gijón, Asturias, España.
| | | | | | - G Viejo-Guerra
- Servicio de Microbiología, Hospital de Cabueñes, Gijón, Asturias, España
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Lateral lumbar retroperitoneal transpsoas approach in the setting of spondylodiscitis: A technical note. J Clin Neurosci 2017; 39:193-198. [PMID: 28159488 DOI: 10.1016/j.jocn.2016.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/26/2016] [Indexed: 11/20/2022]
Abstract
Thoracolumbar spondylodiscitis is a morbid disease entity, impacting a sick patient population with multiple comorbidities. Wherever possible, surgical measures in this population should limit the extent of soft tissue disruption and overall morbidity that is often associated with anteroposterior thoracolumbar decompression and fusion. The authors describe the rationale, technique, and use of the lateral lumbar transpsoas retroperitoneal approach in tandem with posterior decompression and instrumented fusion in the treatment of circumferential thoracolumbar spondylodiscitis with or without epidural abscesses. The authors have routinely implemented the lateral lumbar transpsoas retroperitoneal approaches to address all pyogenic vertebral abscesses, spondylodiscitis, and ventral epidural abscesses with anterior column debridement and reconstruction with iliac crest autograft, posterior decompression, and pedicle screw instrumentation. In five consecutive patients, the mean blood loss and operative duration was 275mL and 259min, respectively. There were no instances of major vascular injury as this corridor obviates the need for retraction of inflamed retroperitoneal structures. The use of the lumbar lateral retroperitoneal transpsoas approach to the lumbar spine for the treatment of destructive and pyogenic spondylodiscitis is a potential alternative to the traditional anterior lumbar retroperitoneal approach in tandem with posterior spinal decompression and instrumented stabilization.
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Gamble JG. Primary Psoas Pyomyositis Presenting as Subluxation of the Hip: A Case Report. JBJS Case Connect 2016; 6:e21. [PMID: 29252727 DOI: 10.2106/jbjs.cc.o.00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE An eight-year-old girl presented with a septic subluxation of the right hip secondary to spontaneous drainage of a psoas pyomyositis. The course of the infection was protracted, and the symptoms were mild relative to the magnitude of the psoas abscess and the volume of purulence in the hip that caused subluxation of the femoral head. At the time of surgical drainage, the hip capsule directly communicated with the psoas abscess along the course of the iliopsoas tendon sheath. Methicillin-sensitive Staphylococcus aureus (MSSA) was the microorganism that was isolated from the abscess and from the hip joint. CONCLUSION Drainage of the psoas abscess and septic arthritis coupled with antibiotic treatment eliminated the infection, and the child returned to normal activities. At the five-year follow-up, she was asymptomatic, but the subtle changes in the sphericity of the femoral head as well as the slight joint-space narrowing may be associated with problems in the future.
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Affiliation(s)
- James G Gamble
- Packard Children's Hospital, Stanford University Medical Center, Stanford, California
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11
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Zou MX, Li J, Lyu GH. Iliopsoas abscess due to brenner tumor malignancy: a case report. Chin Med J (Engl) 2015; 128:423-4. [PMID: 25635448 PMCID: PMC4837883 DOI: 10.4103/0366-6999.150126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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An easily overlooked presentation of malignant psoas abscess: hip pain. Case Rep Orthop 2015; 2015:410872. [PMID: 25685574 PMCID: PMC4320908 DOI: 10.1155/2015/410872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/07/2015] [Indexed: 11/26/2022] Open
Abstract
Psoas abscess is a rare infectious disease with nonspecific clinical presentation that frequently causes a diagnostic difficulty. Its insidious onset and occult characteristics can cause diagnostic delays. It is classified as primary or secondary. Staphylococcus aureus is the most commonly causative pathogen in primary psoas abscess. Secondary psoas abscess usually occurs as a result of underlying diseases. A high index of clinical suspicion, the past and recent history of the patient, and imaging studies can be helpful in diagnosing the disease. The delay of the treatment is related with high morbidity and mortality rates. In this paper, 54-year-old patient with severe hip pain having an abscess in the psoas muscle due to metastatic cervical carcinoma is presented.
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Retroperitoneal metastatic germ cell tumor presenting as a psoas abscess: a diagnostic pitfall. Am J Med Sci 2013; 346:70-2. [PMID: 23360792 DOI: 10.1097/maj.0b013e31827db3fd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most testicular neoplasms are germ cell tumors, the vast majority of which represent seminomas. Most seminomas present localized to the testis, whereas nonseminomatous germ cell tumors more often present with lymph node metastases. Psoas abscesses generally arise from a contiguous intra-abdominal or pelvic infectious process, an adjacent focus of osteomyelitis or septic emboli from distant infectious foci. In this study, the case of a 24-year-old man who presented with a right psoas mass presumptively diagnosed as an abscess secondary to fever and leukocytosis is presented. The patient had a history of right testicular seminoma, and normal serum levels of alpha-fetoprotein and human chorionic gonadotropin. Surgical exploration and biopsy demonstrated seminoma metastasis. This case represents an extremely unusual clinical presentation of metastatic germ cell tumor presenting as a psoas abscess. This unique case represents an unusual presentation of a recurrent germ cell tumor mimicking a psoas abscess. Awareness of possible metastatic testicular germ cell neoplasm as a psoas abscess could prevent diagnosis delay before retroperitoneal tumor debulking.
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Tonolini M, Villa C, Campari A, Ravelli A, Bianco R, Cornalba G. Common and unusual urogenital Crohn's disease complications: spectrum of cross-sectional imaging findings. ACTA ACUST UNITED AC 2013; 37:118-39. [PMID: 22456714 DOI: 10.1007/s00261-011-9764-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Involvement of the urinary tract and genital organs is not uncommon in patients affected with Crohn's disease (CD). Occurring in both sexes, uro-gynecological complications are often clinically unsuspected because of the dominant intestinal or systemic symptoms. Knowledge of their manifestations and cross-sectional imaging appearances is necessary to recognize and report them, since correct medical or surgical treatment choice with appropriate specialist consultation allows to prevent further complications. Besides uncomplicated urinary tract infections that usually do not require imaging, urolithiasis and pyelonephritis represent the most commonly encountered urinary disorders: although very useful, use of computed tomography (CT) should be avoided whenever possible, to limit lifetime radiation exposure. Hydronephrosis due to ureteral inflammatory entrapment and enterovesical fistulization may result from penetrating CD, and require precise imaging assessment with contrast-enhanced CT to ensure correct surgical planning. Representing the majority of genital complication, ano- and rectovaginal fistulas and abscesses frequently complicate perianal inflammatory CD and are comprehensively investigated with high-resolution perianal MRI acquired with phased-array coils, high-resolution T2-weighted sequences and intravenous contrast. Finally, rare gynecological manifestations including internal genital fistulas, vulvar and male genital involvement are discussed.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, Luigi Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
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Tal R, Zonis Z, Sweed Y, Ciceu G, Yulevich A, Glikman D. Perivesical abscesses caused by Staphylococcus aureus in two children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Fernández-Ruiz M, Estébanez-Muñoz M, López-Medrano F, Aguado JM. [Iliopsoas abscess: therapeutic approach and outcome in a series of 35 patients]. Enferm Infecc Microbiol Clin 2011; 30:307-11. [PMID: 22137371 DOI: 10.1016/j.eimc.2011.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/11/2011] [Accepted: 09/12/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The present study was aimed at reviewing the iliopsoas abscess (IPA) from a contemporary perspective, on the basis of experience from two tertiary referral centres. MATERIAL AND METHODS We performed a retrospective analysis of 35 cases of IPA diagnosed between 1998 and 2009. Their clinical and microbiological features were recorded, as well as their long-term outcome according to the type of treatment: antibiotics alone (10 patients), or antibiotics plus percutaneous drainage or surgery (25 patients). RESULTS Primary abscess occurred in 8 patients. The most frequent source of secondary abscesses was spondylodiscitis. The classic clinical triad (fever, pain and functional impairment) was present in 10 patients, with a median duration of symptoms before diagnosis of 12 days. Staphylococcus aureus was the most frequently isolated microorganism. At the end of a median follow-up of 454 days, the risk of poor outcome (related death and/or relapse) was higher among patients with diabetes mellitus (44.4% vs. 7.7%; P=.027), with no significant differences according to the therapeutic approach (20.0% in the group of antibiotics alone vs. 28.0% in the group with drainage or surgery). CONCLUSIONS In our series, most cases of IPA were due to S. aureus and secondary to a skeletal source. Antibiotic therapy seems effective in the long-term, although diabetic patients had a higher risk of relapse.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, España.
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García Montero P, Laguna del Estal P, López-Cano Gómez M, Castañeda Pastor A, Gil Navarro M. [Pyogenic and tuberculous abscesses of the psoas muscle]. Rev Clin Esp 2011; 211:572-8. [PMID: 21982042 DOI: 10.1016/j.rce.2011.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 07/05/2011] [Accepted: 07/24/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of patients with abscess on the psoas muscle (PA) and to identify the possible differences existing between pyogenic and tuberculous etiologies. PATIENTS AND METHODS A retrospective review of patients diagnosed of PA in one hospital was conducted (1983-2009). Two groups were established, that is pyogenic and tuberculous, and the clinical findings, analyses and evolution were compared. RESULTS Thirty PA were included, 83% pyogenic and 17% tuberculous, average age 53 years. On 9 occasions, 30% were primary and on 21 occasions, 70% secondary (to skeletal pathology in 8, to urological in 8 and to gastrointestinal in 8). No clinical differences were observed between both groups. Pyogenic and tuberculous etiologies were differentiated analytically through leukocyte values (13,871 vs. 8,560/mm(3), p=0.018), hemoglobin (11 vs. 14 g/dL, p=0.008) and erythrocyte sedimentation rate (ESR) (108 vs. 17 mm/h, p<0.0001). Abscesses were diagnosed by computed tomography (CT) in 29 patients (97%) and by magnetic resonance in 1 (3%), both with a diagnostic sensitivity of 100%, as opposed to 50% for ultrasound scanning. Left laterality was less frequent in pyogenic abscesses (44% vs. 100%, p=0.031). The blood cultures were positive in 22% and abscess pus culture in 82%. Gram negative bacilli, Streptococcus spp. and S. aureus were the most frequent isolations. A total of 67% were drained: transcutaneously 50%, surgically 13% and both techniques 3%. Two patients died (7%), both with pyogenic abscess. CONCLUSIONS Secondary pyogenic abscesses constitute the most frequent PA group. CT is the diagnostic procedure of choice. Leukocytosis, anemia, raised ESR and right laterality suggest pyogenic etiology. Transcutaneous drainage is substituting surgical drainage and also makes it possible to obtain diagnostic samples.
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Affiliation(s)
- P García Montero
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España.
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[68 years old woman with right leg weakness and colostasis]. ACTA ACUST UNITED AC 2011; 7:208-9. [PMID: 21794815 DOI: 10.1016/j.reuma.2010.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 01/05/2010] [Accepted: 01/07/2010] [Indexed: 11/24/2022]
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Alonso CD, Barclay S, Tao X, Auwaerter PG. Increasing incidence of iliopsoas abscesses with MRSA as a predominant pathogen. J Infect 2011; 63:1-7. [PMID: 21641042 DOI: 10.1016/j.jinf.2011.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Iliopsoas abscesses (IPAs) are rare infections involving purulence within the muscles of the iliopsoas compartment, seldom due to Methicillin-resistant Staphylococcus aureus (MRSA) historically. This study was designed to evaluate the clinical characteristics and outcomes of patients with IPAs. METHODS A retrospective analysis of the demographics, clinical presentation, microbiologic data and treatment modalities among patients with IPAs from 1993 to 2007 at The Johns Hopkins Hospital was performed. RESULTS Among 61 patients with IPAs, infection rates increased from 0.5 cases/10,000 admissions (1993-2004) to 6.5 cases/10,000 admissions (2005-2007) (P < 0.001). An adjacent infectious focus was identified in 80% of patients, from skeletal (48%), intra-abdominal (23%), vascular (5%), genitourinary (3%), and cutaneous sources (2%). During 2005-2007, MRSA became a predominant pathogen, accounting for 25% of all cases and 37% of cases with a definitive microbiologic diagnosis (P = 0.006). Patients with IPAs >2 cm were more likely to undergo drainage, with trends toward longer hospitalizations, longer antibiotic courses, and increased odds of securing a definitive microbiologic diagnosis. CONCLUSIONS Since 2005, rates of IPA have dramatically increased, with MRSA now the leading cause of infection. Knowledge of common pathogens should guide antimicrobial therapy including empiric coverage for MRSA in institutions with similar populations, especially if culture data are not available.
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Affiliation(s)
- Carolyn D Alonso
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
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Lam SK, Wong OF, Lau CL, Fung HT. CT Quiz: A 51-Year-Old Female Presenting with Right Lower Quadrant Pain. HONG KONG J EMERG ME 2011. [DOI: 10.1177/102490791101800311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - OF Wong
- Tuen Mun Hospital, Department of Anaesthesia & Intensive Care, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
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Primary extrahepatic alveolar echinococcosis of the lumbar spine and the psoas muscle. Ann Clin Microbiol Antimicrob 2011; 10:13. [PMID: 21496254 PMCID: PMC3096593 DOI: 10.1186/1476-0711-10-13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 04/15/2011] [Indexed: 02/03/2023] Open
Abstract
Alveolar echinococcosis (AE) of human being caused by Echinococcus multilocularis is a rare but important zoonosis especially in tempered zones of middle Europe and Northern America with endemic character in many countries. Due to the long incubation period, various clinical manifestations, critical prognosis, and outcome AE presents a serious and severe disease. The primary focus of infection is usually the liver. Although secondary affection of visceral organs is possible extrahepatic AE is highly uncommon. Moreover, the involvement of bone and muscle presents with an even lower incidence. In the literature numerous cases on hepatic AE have been reported. However, extrahepatic AE involving bones and/or muscles was described very rarely. We report a case of an 80-year-old man with primary extrahepatic alveolar Echinococcosis of the lumbar spine and the psoas muscle. The etiology, diagnosis, differential diagnoses, treatment options and outcome of this rare disease are discussed in context with the current literature.
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