1
|
Saha D, Tai R, Kapare V, Joshi G. Multifocal emphysematous osteomyelitis, a do not miss diagnosis for the emergency radiologist: a case report with literature review. Emerg Radiol 2024; 31:285-288. [PMID: 38267799 DOI: 10.1007/s10140-024-02203-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence.
Collapse
Affiliation(s)
- Debajyoti Saha
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA.
| | - Ryan Tai
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
| | - Vaishali Kapare
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
| | - Ganesh Joshi
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
| |
Collapse
|
2
|
Schröder C, Calite E, Böckenhoff P, Büttner T, Stein J, Gembruch U, Strizek B. Psoas abscess in pregnancy: a review of the literature and suggestion of minimally invasive treatment options. Arch Gynecol Obstet 2024; 309:987-992. [PMID: 36840770 PMCID: PMC10867082 DOI: 10.1007/s00404-023-06970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
AIM Less than a dozen cases of psoas abscesses in pregnancy have been described in the literature. We reviewed the literature when treating a patient with a psoas abscess after ipsilateral double J-ureteral stent placement (in the following: "double J-stent") due to infected hydronephrosis. METHODS In January 2022, this review was searched using the Pubmed/MEDLINE database and the mesh terms "Psoas Abscess" AND "Pregnancy". Studies were included in any language and of all years, describing a psoas abscess during pregnancy. When patients did not have a psoas abscess, the abscess occurred after pregnancy, or when there was no full text available, the article was excluded. MAIN RESULTS Ten case reports about patients with psoas abscesses during pregnancy were included. The classical symptomatic triad of psoas muscle abscess included lower back pain, limping and persistent fever with daily spikes. However, in most cases, not all three symptoms can be found. Especially, fever is absent in more than half of the patients. Psoas abscesses are described between 13 and 39 weeks of gestation. Primary psoas abscesses with haematogenous spread are more common during pregnancy than secondary with spread per continuitatem. In the literature, the main reasons for psoas abscess are spinal tuberculosis, drug abuse or underlying diseases such as Crohn's disease. It is not uncommon for the definite cause to be unclear. Regarding the patient's symptoms, pyelonephritis is often considered a possible aetiology. In general, the main treatment options include antibiotic treatment and abscess drainage. There is no higher caesarean section rate, and no negative outcome for the foetus has been described. CASE PRESENTATION In our patient, a 38-year-old obese Caucasian woman, who had received a left double J-stent for infected hydronephrosis at 15 weeks of gestation, we successfully treated a psoas abscess of 20 × 10 cm with a sonographically assisted abscess drainage and antibiotics. The further course of pregnancy and the elective repeat caesarean section at 38 + 0 weeks of gestation were without any problems. Double J-stent placement and laser stone lithotripsy during puerperium were performed because of recurrent urolithiasis. CONCLUSIONS Although rare, psoas abscesses can occur during pregnancy, and it has often been treated surgically in the past. A psoas abscess as a complication after infected hydronephrosis and intervention during pregnancy has never been reported in the literature. Even for obese patients, minimally invasive therapy may be a treatment option that has rarely been reported in the literature.
Collapse
Affiliation(s)
- Carolin Schröder
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Elina Calite
- Prenatal Care Dr. Marquet and Bewermeyer, Muffeter Weg 37, 52074, Aachen, Germany
| | - Paul Böckenhoff
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Thomas Büttner
- Department of Urology and Paediatric Urology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Johannes Stein
- Department of Urology and Paediatric Urology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| |
Collapse
|
3
|
Kouadio AF, Bravo-Tsri AEB, Tanoh KE, Kouassi KPB, Yao BL, Kouakou BDM, Sanogo SC, Soro M, Konate I. Incidental finding of Pott's disease with abscesses of the psoas simulating an appendicular syndrome. Radiol Case Rep 2023; 18:4115-4118. [PMID: 37720919 PMCID: PMC10504458 DOI: 10.1016/j.radcr.2023.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Pott's disease or tuberculous spondylodiscitis is the disco-vertebral localization of Koch's bacillus. It causes progressive spinal lesions, with abscesses forming in the perivertebral soft tissues and epidural spaces. Medical imaging plays an indisputable role in the diagnosis and management of Pott's disease. Magnetic resonance imaging (MRI) enables early positive diagnosis and assessment of spinal damage. Computed tomography (CT) is currently the best interventional imaging method for the drainage of soft tissue abscesses and disco-vertebral biopsies for bacteriological and histological purposes. We report a case of accidental discovery of Pott's disease with abscesses of the psoas simulating an appendicular syndrome and describe its epidemiological, clinical, and radiological aspects through a review of the literature.
Collapse
Affiliation(s)
- Allou Florent Kouadio
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Akoli Eklou Baudoin Bravo-Tsri
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Kesse Emile Tanoh
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Kouamé Paul Bonfils Kouassi
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Brou Lambert Yao
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | | | - Sara Carole Sanogo
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
| | - Malick Soro
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
| | - Issa Konate
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| |
Collapse
|
4
|
Priyatharsan K, Balagobi B, Heerthikan K, Thulasi T, Priyanka A, Sureska G. A rare case of renal squamous cell carcinoma presenting with psoas sign. Int J Surg Case Rep 2023; 110:108732. [PMID: 37647754 PMCID: PMC10509870 DOI: 10.1016/j.ijscr.2023.108732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Renal cancer is a relatively common form of cancer; however, squamous cell carcinoma of the kidney is extremely rare and it carries poor prognosis. CLINICAL PRESENTATION We present a rare case of renal squamous cell carcinoma that was manifested with the psoas sign in a patient with a history of chronic staghorn calculus. DISCUSSION Squamous cell carcinoma of kidney is rare and more invasive. Even though many risk factors have been identified, staghorn renal calculi with chronic infection have a higher incidence of renal squamous cell carcinoma (SCC). Squamous cell carcinoma (SCC) has a wider range of atypical presentations; the psoas sign is not commonly reported in other literature. Due to the lack of reporting and sufficient knowledge, there are currently no established management guidelines. Despite advancements in contemporary medicine, the survival rate of renal SCC remains remarkably low, necessitating further research to develop a standardized treatment protocol. CONCLUSION Primary renal SCCs are rare tumors and exhibit a strong association with renal stones, requiring prompt assessment and treatment of renal stones in affected patients. Despite their aggressiveness and poor prognosis, timely intervention is crucial.
Collapse
Affiliation(s)
- K Priyatharsan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka.
| | - B Balagobi
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | - K Heerthikan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | - T Thulasi
- Department of Radiology, Teaching Hospital Jaffna, Sri Lanka
| | - A Priyanka
- National Cancer Institute, Maharagama, Sri Lanka
| | - G Sureska
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| |
Collapse
|
5
|
Barchi L, Fastiggi M, Bassoli I, Bonvicini F, Silvotti M, Iughetti L, De Fanti A. Pyomyositis associated with abscess formation caused by streptococcus pneumoniae in children: a case report and review of literature. Ital J Pediatr 2023; 49:73. [PMID: 37316947 DOI: 10.1186/s13052-023-01472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/11/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Pyomyositis is an unusual bacterial infection but potential severe in children. Staphylococcus Aureus is the main caused of this disease (70-90%), following by Streptococcus Pyogenes (4-16%). Streptococcus Pneumoniae rarely caused invasive muscular infections. We describe a case of pyomyositis caused by Streptococcus Pneumonia in an adolescent 12-year-old female. CASE PRESENTATION I.L. referred to our hospital for high fever associated with right hip and abdominal pain. The blood exams showed increase of leukocytes with prevalence of neutrophils with high level of inflammatory markers (CRP 46,17 mg/dl; Procalcitonin 25,8 ng/ml). The abdomen ultrasonography was unremarkable. The CT and MRI of the abdomen and right hip revealed pyomyositis of the iliopsoas, piriformis and internal shutter associated with collection of pus between the muscular planes (Fig. 1). The patient was admitted to our paediatric care unit, and she was initially treatment with intravenous Ceftriaxone (100 mg/kg/day) and Vancomycin (60 mg/kg/day). On day 2, a pansensitive Streptococcus Pneumoniae was isolated from the blood culture, and the antibiotic treatment was changed to only IV Ceftriaxone. She was successively treated with IV Ceftriaxone for 3 weeks, then continued with oral Amoxicillin for a total of 6 weeks of therapy. The follow up showed a complete resolution of the pyomyositis and psoas abscess after 2 months. CONCLUSION Pyomyositis associate with abscess is a rare and very dangerous disease in children. The clinical presentation can mimic symptoms of other pathologies like osteomyelitis or septic arthritis, so many times is hard to identify. The main risk factors include story of recent trauma and immunodeficiency, not present in our case report. The therapy involves the antibiotics and, if possible, abscess drainage. In literature there is much discussion about duration of antibiotic therapy.
Collapse
Affiliation(s)
- Luca Barchi
- School of Pediatric, University of Modena and Reggio Emilia, Modena, 41224, Italy.
| | - Michele Fastiggi
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, 42123, Italy
| | - Ilaria Bassoli
- School of Pediatric, University of Modena and Reggio Emilia, Modena, 41224, Italy
| | - Federico Bonvicini
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, 42123, Italy
| | - Monica Silvotti
- Unit of Radiology, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, 42123, Italy
| | - Lorenzo Iughetti
- School of Pediatric, University of Modena and Reggio Emilia, Modena, 41224, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, 42123, Italy
| |
Collapse
|
6
|
Yagdiran A, Paul G, Meyer-Schwickerath C, Scheder-Bieschin J, Tobys D, Kernich N, Eysel P, Jung N. Clinical features and outcome of vertebral osteomyelitis after spinal injection: is it worth the price? Infection 2023; 51:599-607. [PMID: 37071309 DOI: 10.1007/s15010-023-02024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Spinal injections are increasingly used for back pain treatment. Vertebral osteomyelitis (VO) after spinal injection (SIVO) is rare, but patient characteristics and outcome have not been well characterized. The aim of this study was to assess patient characteristics of SIVO in comparison to patients with native vertebral osteomyelitis (NVO) and to determine predictors for 1-year survival. METHODS This is a single-center cohort study from a tertiary referral hospital. This is a retrospective analysis of Patients with VO who were prospectively enrolled into a spine registry from 2008 to 2019. Student's t-test, Kruskal-Wallis test or Chi-square test were applied for group comparisons. Survival analysis was performed using a log-rank test and a multivariable Cox regression model. RESULTS 283 VO patients were enrolled in the study, of whom 44 (15.5%) had SIVO and 239 (84.5%) NVO. Patients with SIVO were significantly younger, had a lower Charlson comorbidity index and a shorter hospital stay compared to NVO. They also showed a higher rate of psoas abscesses and spinal empyema (38.6% [SIVO] vs. 20.9% [NVO]). Staphylococcus aureus (27%) and coagulase-negative staphylococci (CNS) (25%) were equally often detected in SIVO while S. aureus was more frequently than CNS in NVO (38.1% vs. 7.9%).Patients with SIVO (P = 0.04) had a higher 1-year survival rate (Fig. 1). After multivariate analysis, ASA score was associated with a lower 1-year survival in VO. CONCLUSION The results from this study emphasize unique clinical features of SIVO, which warrant that SIVO should be estimated as a separate entity of VO.
Collapse
Affiliation(s)
- Ayla Yagdiran
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Gregor Paul
- Department of Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.
| | | | - Justus Scheder-Bieschin
- Department of Interdisciplinary Acute, Emergency and Intensive Care Medicine (DIANI), Klinikum Stuttgart, Stuttgart, Germany
| | - David Tobys
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Norma Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| |
Collapse
|
7
|
Tokuyama Y, Yamada H, Shinozuka K, Yunoki T, Ohtsuru S. Pyogenic sacroiliitis caused by Salmonella schwarzengrund in a young healthy woman: a case report and literature review. Int J Emerg Med 2023; 16:21. [PMID: 36941606 PMCID: PMC10026423 DOI: 10.1186/s12245-023-00496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Salmonella species are a leading cause of diarrheal diseases worldwide. Recent epidemiological studies have shown that Salmonella schwarzengrund (S. schwarzengrund) is highly prevalent in various regions. Herein, we report that S. schwarzengrund caused sacroiliac joint (SIJ) infection with septic shock in a young woman, although she was immunocompetent. CASE PRESENTATION A 20-year-old woman presented with left hip pain, accompanied by vasopressor-requiring hypotension. Her imaging examinations showed fluid collection in her SIJ and a small abscess in the left iliac muscle. Later, the blood and aspiration fluid culture and genetic analysis revealed the presence of S. schwarzengrund. We diagnosed sacroiliac joint (SIJ) infection with septic shock caused by S. schwarzengrund. Her condition improved after performing several interventional radiology (IVR) procedures for SIJ abscesses and providing appropriate antibiotic treatment. Finally, she was discharged without any sequelae. Screening tests and genetic analysis about her immunodeficiency did not indicate a congenital disorder. CONCLUSION These clinical courses indicate that S. schwarzengrund could cause the fatal SIJ infection irrespective of the host immunocompetence. Considering the recent increase in the diagnostic rate of S. schwarzengrund, this case emphasized the need to be more cautious about Salmonella species infection.
Collapse
Affiliation(s)
- Yuki Tokuyama
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Yamada
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Shinozuka
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
| | - Tomoyuki Yunoki
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
| | - Shigeru Ohtsuru
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan.
| |
Collapse
|
8
|
Leković A, Živković V, Ječmenica D, Nikolić S. Extensive direct spreading of "groin hit"-related soft tissue infections: a report of three cases. Forensic Sci Med Pathol 2023; 19:117-20. [PMID: 35849278 DOI: 10.1007/s12024-022-00493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
We present fatal extensive soft tissue infections, a consequence of groin heroin injection, in three subjects, who were 27, 34, and 39 years old and had a history of over 10-, 15-, and 5-years of heroin injection (cases 1, 2, and 3, respectively). In all cases, the first symptoms of the infection appeared at least a week prior, with rapid deterioration on the last day. The hallmark was a disproportion between external and internal findings in the affected thighs. The latter presented as extensively spread suppurative inflammation with soft tissue necrosis. In case 1, subtle skin erythema was present in the left groin, with a wound suggestive of a recent abscess incision and injection-related scarring. However, dissection revealed that inguinal regions and deep soft tissue (including the muscle sheets) of the left thigh, gluteal region, and lower third of the anterior abdominal wall were inflamed with pus, alongside fibrinopurulent peritonitis. Case 2 had pronounced erythema and swelling of the thigh and knee. Diffuse suppuration was observed upon dissection in the inguinal regions, which extended into the iliopsoas muscles, with soft tissue and muscle necrosis. In the abdominal cavity, we detected 150 mL of serofibrinous exudate. Only case 3 had a prominent, 4 × 3.5-cm necrotic skin defect through which pus spontaneously drained. In contrast to the other two, although extensive pus collection within predominantly necrotic thigh's soft tissue was present, the inflammation did not expand above the inguinal ligament, and peritonitis was not observed. Toxicology analysis excluded acute heroin intoxications.
Collapse
|
9
|
Pinto MYP, Salim J. A rare presentation of ilio psoas abscess - A case report. Int J Surg Case Rep 2022; 102:107832. [PMID: 36512883 PMCID: PMC9761371 DOI: 10.1016/j.ijscr.2022.107832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Psoas abscesses are usually confined to the psoas compartment due to its fascial attachments. However, in rare situations, the infection can locally spread beyond the psoas sheath. CASE PRESENTATION A 65-year-old patient presented with; 3 weeks of lower back and right hip pain, progressive inability to walk and one week of urinary incontinence. CT abdomen showed a right psoas abscess with pneumo-retroperitoneum extending to the right gluteus muscle, posterior compartment of the upper thigh and mediastinum. Exploration in theatre showed copious amounts of pus, visible between the fascial layers and muscles of the thigh, tracking to the level of the knee and the gluteal region. DISCUSSION Psoas abscesses are usually confined to the psoas compartment. However, in this case, it was spread to the posterior compartment of the thigh, gluteal region and pelvis with fascial necrosis and pus. Due to the extensive nature of the disease and the patient's clinical deterioration, he underwent open drainage of the psoas abscess, exploration and debridement of the posterior compartment of thigh and gluteal region with a good outcome. CONCLUSION Psoas abscesses can penetrate the psoas sheath to cause extra pelvic extension. A high index of suspicion and early imaging, if necessary, should be arranged if in doubt. Depending on the clinical severity, patients may need to be managed with open drainage and debridement than conventional CT-guided drainage.
Collapse
Affiliation(s)
- Mihindukulasuriya Yvonne Presadini Pinto
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia,Corresponding author at: Department of General Surgery, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia.
| | - Joshua Salim
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia,University of Western Australia, Western Australia, Australia
| |
Collapse
|
10
|
Grayaa M, Ben Jomaa S, Saadi S, Ben Hammouda S, Ben Abdeljelil N, Oualha D, Haj Salem N. A missed psoas abscess diagnosis: A forensic case report. Forensic Sci Med Pathol 2022; 18:240-243. [PMID: 35262872 DOI: 10.1007/s12024-022-00464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/14/2022]
Abstract
Psoas abscess is a rare pathology that usually presents with non-specific signs and rare clinical features. These characteristics can delay the diagnosis leading to complications and death. We report a forensic autopsy case of a 65-year-old male, alcoholic, smoker, with a history of hypertension, and urinary infection, who presented to the emergency room for anorexia and consciousness disorder. On physical examination, the patient was febrile and confused. Laboratory exams revealed leukocytosis and elevated C-reactive protein (CRP). Two days later, he died despite extensive resuscitation. Forensic autopsy revealed a large amount of green pus in the left psoas muscle extending to the muscles of the thigh of the same side with multiple cavities. The pus extended to the left kidney with destructive parenchyma and coralliform lithiasis. Histological examination showed destroyed renal tissue by lesions of chronic and acute pyelonephritis with dilatation of the pyelocaliceal cavities. Bacteriological analysis of the pus showed the presence of Escherichia coli. The psoas abscess was secondary to pyonephrosis favored by the immunodeficiency. Thus, death was attributed to a septic shock secondary to a psoas abscess complicating pyonephrosis.
Collapse
Affiliation(s)
- Meriem Grayaa
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia. .,Faculty of Medicine, University of Monastir, Monastir, Tunisia.
| | - Sami Ben Jomaa
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Said Saadi
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Seifeddine Ben Hammouda
- Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Nouha Ben Abdeljelil
- Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Dorra Oualha
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nidhal Haj Salem
- Department of Forensic Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, Tunisia
| |
Collapse
|
11
|
Richards T, Stephen J, Lui CL. Severe disseminated Veillonella parvula infection including endocarditis, bilateral psoas abscess, discitis, and osteomyelitis but sparing spinal and hip prostheses: a case report. J Med Case Rep 2022; 16:157. [PMID: 35440093 PMCID: PMC9020012 DOI: 10.1186/s13256-022-03386-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/23/2022] [Indexed: 11/11/2022] Open
Abstract
Background Veillonella species are an opportunistically pathogenic commensal anaerobic Gram-negative coccus commonly found in the oral, genitourinary, respiratory, and intestinal tract of humans and some animals. Infection is rare, even in immunocompromised hosts, and has been identified to cause a wide array of different infections, including endocarditis, osteomyelitis, and meningitis. Case presentation An 82-year-old Caucasian male retired ex-gymnast presented to the emergency department with a 2-week history of acute on chronic lower back pain without clear precipitant. He displayed no systemic symptoms, and had not sustained any recent injuries. Initial blood and radiological investigation did not reveal an infective or mechanical cause for his pain; however, a few days into admission, he developed a fever and signs of sepsis. A thorough septic screen was performed, including a spinal magnetic resonance imaging scan, which did not reveal any abnormalities. Blood cultures revealed Veillonella parvula bacteremia, with subsequently repeated magnetic resonance imaging displaying rapid disseminated infection including bilateral psoas abscess, discitis, and osteomyelitis. Infective endocarditis was later identified with echocardiogram. He received intravenous ceftriaxone and later oral amoxicillin and clavulanic and recovered on 6-month follow-up. Conclusions This case illustrates the potential pathogenicity and unexpected rapid course of Veillonella parvula infection even in an immunocompetent host presenting with back pain. This case highlights the critical importance of a thorough septic screen when investigating patients for early signs of sepsis.
Collapse
Affiliation(s)
- Tobias Richards
- Geriatric Medicine, St John of God Midland Public and Private Hospitals, 1 Clayton St, Midland, WA, 6056, Australia.
| | - Juan Stephen
- Geriatric Medicine, St John of God Midland Public and Private Hospitals, 1 Clayton St, Midland, WA, 6056, Australia
| | - Chok Lin Lui
- Geriatric Medicine, St John of God Midland Public and Private Hospitals, 1 Clayton St, Midland, WA, 6056, Australia
| |
Collapse
|
12
|
Parmar G, Soin P, Sharma P, French C, Han B, Kochar PS. Sequestered disc herniation mimicking psoas abscess: A rare case report. Radiol Case Rep 2021; 17:223-226. [PMID: 34824655 PMCID: PMC8605185 DOI: 10.1016/j.radcr.2021.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022] Open
Abstract
Intervertebral disc herniation is common condition, with majority occurring in lumbar and cervical spine. Most lumbar disk herniations occur within the spinal canal, with approximately 7%-10% identified within the foramen or extraforaminal location. Extraforaminal disc herniation in extreme lateral, retroperitoneal or anterior terms are used when disc material is seen towards anterolateral or anterior to the spine. Disc herniation in these locations is easily mistaken for an abscess or a neoplasm especially when it is not connected to the parent disc (sequestered disc). We describe a case of 60-year male who initially was misdiagnosed as psoas abscess and subjected to invasive investigation which later turned out to be histologically confirmed disc sequestration in the retroperitoneum. Thus, knowledge of this condition is essential in avoiding unnecessary workup and treatment.
Collapse
Affiliation(s)
- Gaurav Parmar
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA
| | - Priti Soin
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Pranav Sharma
- Department of Radiology, University of Minnesota Medical Center, 420 Delaware St SE Minneapolis, Minneapolis, MN 55455, USA
| | - Christy French
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17043, USA
| | - Bing Han
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Puneet S Kochar
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17043, USA
| |
Collapse
|
13
|
Cheung KO, Lui TH, Tam CWY, Tam KFG. Ruptured mycotic iliac artery aneurysm presenting as infected psoas haematoma and mimicking psoas abscess. Radiol Case Rep 2021; 16:3776-82. [PMID: 34646408 DOI: 10.1016/j.radcr.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 12/01/2022] Open
Abstract
Pseudoaneurysm of the iliac arteries are rarely reported in the literature. Failure to identify the pathology may delay the necessary treatment, and potentially lead to high mortality. We report a case of ruptured mycotic iliac artery aneurysm in a 46-year-old man with newly diagnosed diabetes mellitus. Initial CT appearance mimicked psoas abscess. However, further CT showed features more suggestive of a psoas haematoma with heterogeneous hyperdensities within the lesion. A ruptured mycotic iliac artery aneurysm was diagnosed. Patient was urgently referred to the vascular team for endovascular stenting. Blood-stained purulent material was noted in the left psoas muscle intra-operatively. It was drained and sent for culture, which later yielded Salmonella Enteritidis sensitive to cefotaxime. We present this case to highlight the importance of reviewing any pre-contrast intramuscular hyperdensities which may suggest acute blood content, and raise suspicion of adjacent vascular pathologies.
Collapse
|
14
|
Mandal SK, Shikhrakar S, Regmi BU, Bam S. A rare occurrence of psoas abscess with uterine didelphys and renal agenesis: A case report. Ann Med Surg (Lond) 2021; 69:102802. [PMID: 34527237 PMCID: PMC8429909 DOI: 10.1016/j.amsu.2021.102802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction Mullerian duct anomaly such as uterine didelphys is a rare congenital anomaly of female genitourinary tract presenting with dysmenorrhea, hematocolpus, and subfertility in adolescent females. It is commonly associated with wolffian duct anomaly like renal agenesis. Here we present a rare association of psoas abscess with uterine didelphys and renal agenesis in a 21-year-old unmarried female. Case presentation We report a case of 21-year-old female presenting with right hip pain, recurrent genital infections and dysmenorrhea. Her labs suggested infectious etiology whereas radiological investigation revealed right psoas abscess. In addition, she was found to have uterine didelphys with pyometra, right adnexal mass, and right renal agenesis. Clinical discussion Uterine didelphys commonly present with dysmenorrhea and hematocolpos along with various non-specific symptoms. Patients can develop psoas abscess secondary to uterine didelphys, but uterine didelphys presenting with psoas abscess is fairly rare. Psoas abscess on itself is a difficult condition to diagnose, more so when associated with rare uterine anomalies. Conclusion This case highlights the possibility of psoas abscess as a primary presentation of Mullerian duct anomaly. Further, a differential of uterine didelphys should be considered in every reproductive age female presenting with recurrent pelvic infection. When a reproductive-age women presents with recurrent pelvic infections, a differential of Mullerian duct anomalies should always be sought out despite the absence of its classical symptoms. Uterine didelphys can also present with rectal, abdominal, or hip pain due abscess formation in related organs and surrounding communicating structures. Our case is an example of atypical presentation of uterine didelphys where the patient presented with psoas abscess which is rare in this entity.
Collapse
Affiliation(s)
- Sujit Kumar Mandal
- Department of Obstetrics and Gynecology, Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal
| | - Shreeja Shikhrakar
- Department of Obstetrics and Gynecology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Binit Upadhaya Regmi
- Department of Obstetrics and Gynecology, Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal
| | - Shiba Bam
- Department of Obstetrics and Gynecology, Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal
| |
Collapse
|
15
|
Lucero C, Díaz-Dilernia F, Comba F, Zanotti G, Piccaluga F, Buttaro M. Six-stage revision surgery of a triple periprosthetic joint infection due to a delayed diagnosis of a bilateral psoas abscess: a case report. Ann R Coll Surg Engl 2021; 103:e305-e310. [PMID: 34414782 DOI: 10.1308/rcsann.2021.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CASE We present a case of a 70-year-old woman with simultaneous periprosthetic joint infection (PJI) of both hips and left knee due to a bilateral psoas abscess. The patient underwent debridement and implants removal with the consequent reimplantation in a sequential six-stage revision surgery. At four years of follow-up and in spite of the patient's comorbidities and current PJI presentation, she maintains full activities of daily living without restrictions. CONCLUSION Accurate and early diagnosis of a psoas abscess is crucial. This case report provides experience of a complex scenario, the decision-making involved and the outcomes of an underdiagnosed complication.
Collapse
Affiliation(s)
- C Lucero
- Hospital Italiano de Buenos Aires, Argentina
| | | | - F Comba
- Hospital Italiano de Buenos Aires, Argentina
| | - G Zanotti
- Hospital Italiano de Buenos Aires, Argentina
| | - F Piccaluga
- Hospital Italiano de Buenos Aires, Argentina
| | - M Buttaro
- Hospital Italiano de Buenos Aires, Argentina
| |
Collapse
|
16
|
Taha DE, Raheem AA, Aljarbou A, Haresy MY, Alrubat A, Alowidah I. Concurrent bilateral emphysematous pyelonephritis and secondary iliopsoas abscess extending to thigh muscles with profuse rectal bleeding. A rare case scenario. Int J Surg Case Rep 2021; 86:106289. [PMID: 34412005 PMCID: PMC8377530 DOI: 10.1016/j.ijscr.2021.106289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Bilateral emphysematous pyelonephritis is exceedingly rare. CASE PRESENTATION A 56 year old diabetic male presented with high grade fever 40o c, chills, and bilateral loin pain since two weeks a picture of septic shock. CT showed bilateral emphysematous pyelonephritis, the left kidney was smaller in size, the right renal unit showed marked hydronephrosis, right iliopsoas abscess extending to the thigh. The patient was managed by bilateral nephrostomy tubes and two retroperitoneal drains. Initially, the patient recovered, but the general condition deteriorated and profuse rectal bleeding occurred. Colonoscopy showed bleeding colonic mucosa. CONCLUSION Bilateral emphysematous pyelonephritis is devastating disease that should be managed promptly to avoid septic shock.
Collapse
Affiliation(s)
- Diaa-Eldin Taha
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia; Urology department, Kafrelsheikh University, Egypt.
| | - Ali Abdel Raheem
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia; Urology Department, College of Medicine, Tanta University, Tanta, Egypt
| | | | | | | | - Ibrahim Alowidah
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
17
|
Prabhu RM, Koshire SR, Khandelwal RCS. A Rare Case of Psoas Abscess Secondary to Mucinous Adenocarcinoma of the Appendix: A Case Report. J Orthop Case Rep 2021; 11:1-5. [PMID: 35004364 PMCID: PMC8686507 DOI: 10.13107/jocr.2021.v11.i08.2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Iliacus and psoas muscles are located in an extraperitoneal location forming the iliopsoas compartment. Iliopsoas abscess is a myositis involving this compartment. Pseudomyxoma peritonei is characterized by an abundant extracellular collection of mucin in the peritoneal cavity. When this collection is retroperitoneal, it is termed as pseudomyxoma extraperitonei. We present to you the case of a 52-year-old female with psoas abscess secondary to mucinous adenocarcinoma of the appendix, which was later diagnosed as pseudomyxoma extraperitonei. CASE PRESENTATION A 52-year-old female presented with pain in the right flank with discharging sinuses since one year. She had previously undergone two surgeries in the past 1 year for drainage of the abscess and had taken first line anti-tubercular treatment for around 6 months. She was managed in our institute by an open drainage of the abscess. The culture reports showed an infection with E. coli. The histopathology sections showed abundant pools of extracellular mucin with strips of columnar epithelium which indicated the pathology to be a mucinous adenocarcinoma. A contrast-enhanced computed tomography scan of the abdomen and pelvis showed a ruptured appendix mucocele and a collection in the right psoas muscle showing fistulous communication with the cecum and extending to the suture site in the right flank. Anti-tubercular treatment was stopped and an oncology opinion was taken. The patient was managed with a palliative ileostomy. CONCLUSION It is important to keep in mind diagnostic possibilities other than tuberculosis of the spine when managing a patient with an iliopsoas abscess. These include pathologies of the gastrointestinal and genitourinary tract, which need to be diagnosed and managed early.
Collapse
Affiliation(s)
- Rudra M Prabhu
- Department of Orthopaedics, Seth G.S Medical College and KEM Hospital, Mumbai. Maharashtra. India
| | - Spandan R Koshire
- Department of Orthopaedics, Seth G.S Medical College and KEM Hospital, Mumbai. Maharashtra. India
| | - R C S Khandelwal
- Department of Orthopaedics, Seth G.S Medical College and KEM Hospital, Mumbai. Maharashtra. India
| |
Collapse
|
18
|
Al-Hajjaj M, Alsultan M, Swed S. Metal shrapnel causing psoas abscess: The first case report. Int J Surg Case Rep 2021; 84:106092. [PMID: 34119942 PMCID: PMC8209064 DOI: 10.1016/j.ijscr.2021.106092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/05/2021] [Accepted: 06/05/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Iliopsoas abscess is defined as the accumulation of suppurative fluid within the fascia surrounding the psoas and iliac muscles. Although some cases reported psoas abscess due to foreign body, to the best of our knowledge this is the first case of metal shrapnel causing psoas abscess. CASE PRESENTATION A 41 years old male presented to our center after a landmine explosion. After a 24-h of monitoring, he was discharged with no complaints. Later he presented with septicemia, antalgic gait, and low back pain. Computed tomography showed right psoas abscess with metal shrapnel inside. By Anterolateral approach, we drained the retroperitoneal abscess and extracted the metal shrapnel. Follow-up for 6 months revealed no recurrence. CLINICAL DISCUSSION Iliopsoas abscess is one of the challenging cases that urologists face. We presented a patient with penetrating trauma that led to cause psoas abscess. Computed tomography is considered an excellent imaging study to evaluate such patients. Most cases of psoas abscesses treated with antibiotics and minimally invasive drainage. However, with our case, we performed open surgery to extract the metal shrapnel. CONCLUSION Psoas abscess with metal shrapnel should be treated emergently. Patients with penetrating trauma should be evaluated strictly. Follow-up is essential in patients with a history of landmine explosion. Psoas abscess with metal shrapnel inside should be treated with broad-spectrum antibiotics and open surgery for drainage.
Collapse
Affiliation(s)
- Maher Al-Hajjaj
- Department of Urology, Aleppo University Hospital, Aleppo, Syria.
| | - Mohammad Alsultan
- Department of Nephrology, Al Assad and Al Mouwasat University Hospital, Damascus, Syria
| | - Sarya Swed
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| |
Collapse
|
19
|
Akel O, Raju B, Suresh SC, Jumah F, Gupta G, Nanda A. Multiple cerebral hemorrhages in sepsis-disseminated intravascular coagulation versus septic embolism: An image report. Surg Neurol Int 2021; 12:185. [PMID: 34084613 PMCID: PMC8168679 DOI: 10.25259/sni_810_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Septic emboli are commonly attributed to infective endocarditis and can present with a variety of symptoms including altered mental status and focal neurological deficits. Here, we reviewed images of septic emboli with hemorrhagic conversion in a patient with sepsis and a psoas abscess. We aim to show the classical image findings in septic embolism to brain, which is sparsely described in literature and the report differentiates the septic embolism from disseminated intravascular coagulation which can present with almost identical image findings. Case Description: A 53-year-old male patient who was operated on for a right inguinal hernia developed a postoperative wound infection 2 weeks after surgery and was started on IV antibiotics. Despite medical management, his infection did not improve, prompting a computed tomography (CT) scan which revealed a psoas abscess. The abscess was drained, and antibiotics continued. A few days later, he developed altered sensorium prompting a head CT which revealed septic emboli and hemorrhage at the gray-white junction. Cultures grew multidrug-resistant Escherichia coli; the patient was treated with IV tigecycline and improved over the following 4 weeks. Conclusion: In patients with a known ongoing infectious process with hemodynamic stability who develop altered mental status in the setting of a normal coagulation profile, D-dimer, positive blood cultures, and absent signs of multiorgan failure, a diagnosis of septic emboli should be entertained. Although CT can reveal macrobleeds, MRI is more sensitive in confirming cerebral microbleeds. Thus, patients in sepsis with unexplained altered sensorium should undergo an MRI of the brain to rule out septic emboli and microbleeds.
Collapse
Affiliation(s)
- Omar Akel
- Department of Neurosurgery, Rutgers - Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Bharath Raju
- Department of Neurosurgery, Rutgers - Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Sumatha Channapatna Suresh
- Department of Neurosurgery, Rutgers - Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Fareed Jumah
- Department of Neurosurgery, Rutgers - Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Gaurav Gupta
- Department of Neurosurgery, Rutgers - Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Anil Nanda
- Department of Neurosurgery, Rutgers - Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| |
Collapse
|
20
|
Sato T, Kudo D, Kushimoto S. Epidemiological features and outcomes of patients with psoas abscess: A retrospective cohort study. Ann Med Surg (Lond) 2021; 62:114-118. [PMID: 33520205 PMCID: PMC7819806 DOI: 10.1016/j.amsu.2021.01.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background Psoas abscess (PA) is an uncommon disease. Although PA is associated with significant morbidity and mortality, its epidemiology and clinical characteristics remain unknown. This study aimed to evaluate the epidemiological and clinical features and outcomes of patients with PA in a prefectural-wide study. Materials and methods This was a multicenter retrospective cohort study conducted between 2010 and 2012 in the Miyagi prefecture with a population of 2,344,062 in 2011. Adult patients with PA were enrolled from 71 secondary and tertiary care hospitals. Results There were 57 patients with adult PA in the Miyagi prefecture. The median age of the patients was 72 years, and 67% patients were male. Fever and flank pain were the primary symptoms in 82% and 74% of patients, respectively. Ten patients (18%) had septic shock, and the hospital mortality rate was 12%. Secondary PA was present in 72% of cases, and the most common origin was pyogenic spondylitis. Of the patients with secondary PA, 44% had an epidural abscess. The most common pathogens were Staphylococcus aureus, and 11% (6 cases) of the cases were caused by methicillin-resistant S. aureus. Conclusion In the Miyagi prefecture of Japan, the estimated prevalence of PA was 1.21/100,000 population years and hospital mortality was 12%. Secondary PA accounted for more than 70% of the cases, and S. aureus was the most common causative pathogen. The hospital mortality rate of psoas abscess (PA) was 12% in Japan. Estimated prevalence of PA was 1.21/10,000 population years between 2010 and 2012. Secondary PA: >70% of cases with the most common origin as pyogenic spondylitis. Epidural abscess formed in 44% of patients. The most common pathogen was Staphylococcus aureus.
Collapse
Affiliation(s)
- Takeaki Sato
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Daisuke Kudo
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shigeki Kushimoto
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| |
Collapse
|
21
|
Ngoo A, Hirst J. Ureteric calculus with migration into psoas muscle - Case report and literature review. Urol Case Rep 2021; 35:101552. [PMID: 33437646 PMCID: PMC7787960 DOI: 10.1016/j.eucr.2020.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 12/04/2022] Open
Abstract
Urolithiasis is a common condition managed by urologists. We present a rare CASE of a ureteric calculus migrating into the patient's psoas muscle in context of chronic infection and obstruction and summarize the literature surrounding this phenomenon. To our knowledge, only four cases have previously been presented in the literature of obstructing calculi migrating into the retroperitoneum. Our case is the first in which there was no associated psoas abscess and the migrated calculus has remained in situ without any further sequelae.
Collapse
Affiliation(s)
- Alexander Ngoo
- Department of Urology, Mater Hospital Brisbane, Queensland, Australia
| | - Jodi Hirst
- Department of Urology, Mater Hospital Brisbane, Queensland, Australia
| |
Collapse
|
22
|
Das R, Chandrasekar S, Purohit G, Satapathy AK, John J, Mohapatra S, Mishra B. "There is more than what meets the eye" - Extensive spinal tuberculosis presenting as ocular tuberculosis. Indian J Tuberc 2020; 67:404-6. [PMID: 32825880 DOI: 10.1016/j.ijtb.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/11/2019] [Accepted: 11/03/2019] [Indexed: 11/24/2022]
Abstract
Ocular tuberculosis (OTB) is a rare form of extrapulmonary Tuberculosis (EPTB) and a rare presenting feature of tuberculosis (TB) in children. We report such a case in a 3-year-old boy who presented with a painless swelling over left upper eyelid. Mycobacterium tuberculosis bacilli were isolated from the swelling by a Fine Needle Aspiration Cytology (FNAC) which confirmed the diagnosis. Investigating him for the extent of disease, we found him to have intracranial extension to involve the ethmoid sinus on contrast enhance Computed Tomography and Pott's disease causing a compression fracture of L3 with bilateral paravertebral collection, epidural extension and a left psoas abscess on Magnetic Resonance Imaging. After starting antitubercular therapy, the child is doing well and on regular follow up. We are presenting this case to highlight the fact that extensive spinal tuberculosis can present without any neurological deficit and may even present only as a benign looking orbital swelling.
Collapse
|
23
|
Ibrahim FMF, El-Rady AERMA. Transverse process osteotomy for surgical drainage of primary ilio psoas abscess and secondary cases combined with spondylodiscitis. Int Orthop 2020; 45:165-171. [PMID: 32712788 DOI: 10.1007/s00264-020-04732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
Iliopsoas abscess refers to collection of fluid in iliopsoas muscle compartment. It is well-known condition in medical history as a complication of tuberculous spine infection. Most of the cases now are due to pyogenic infection. Patient usually presents late due to delayed diagnosis. We aim to present a less invasive technique for surgical drainage of iliopsoas abscess. PATIENTS AND METHODS It is a prospective study done between 2015 and 2018. The study included 28 patients with confirmed diagnosis of iliopsoas abscess. Laboratory investigations included CBC, ESR, and C-reactive protein that were done for all patients. MRI with contrast enhancement was gold standard for diagnosis. Ten patients underwent surgical psoas abscess drainage by transverse process osteotomy via Wiltse approach without any other spine intervention. Eighteen patients had posterior spine fixation and interbody fusion together with transverse process osteotomy and abscess drainage as treatment for spondylodiscitis. The patients were followed up for clinical improvement, and functional assessment was done by Oswestry disability index. ESR and CRP were used for laboratory follow-up of infection subsidence. Follow-up of abscess size and resolution was done by pelvic-abdominal ultrasonography. RESULTS The mean maximum width of the abscesses in MRI axial views was 38.8 mm. Patients were divided into two groups. Group (1) included ten patients who underwent drainage only while group (2) included 18 patients who underwent spine fusion for treatment of spondylodiscitis. The amount of pus drained intra-operatively was of average 234 cc in group 1 and 191.6 in group 2. The drain was removed in average 58.6 hours post-operatively in group 1 with mean of 168.4 cc of drained fluid and in average of 74.3 hours for group 2 with mean of 350.5 cc of drained fluid. The ODI and inflammatory markers improved in all patients. The follow-up period was of average 26.7 months. The organism was isolated from 19 patients (5 patients were tuberculous and 14 patients were different pyogenic pathogens). No fluid recollection was observed in pelvic-abdominal ultrasound during follow-up in our series. CONCLUSION Transverse process osteotomy is a safe and effective approach for drainage of psoas abscess. It can be done alone or combined with posterior spine fusion for treatment of spondylodiscitis.
Collapse
|
24
|
Zhang Z, Hao Y, Wang X, Zheng Z, Zhao X, Wang C, Zhang X, Zhang X. Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis - a long-term retrospective study of 106 cases. BMC Musculoskelet Disord 2020; 21:353. [PMID: 32505204 PMCID: PMC7276089 DOI: 10.1186/s12891-020-03344-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. Methods A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI). Results The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination. Conclusion MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
Collapse
Affiliation(s)
- Zhifa Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Yongyu Hao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xiangyu Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Zhirong Zheng
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xuelin Zhao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Chunguo Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xifeng Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
| | - Xuesong Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
| |
Collapse
|
25
|
Abstract
Vertebral fracture with muscle hematoma is occasionally seen in practice. However, air-containing hematoma mimicking abscess has not been reported. We present an 87-year-old man with back pain after a fall. Computed tomography scan demonstrated vertebral fracture of L1 and low-density lesions with air bubble in the left crus of the diaphragm and left psoas muscle that were verified to be muscle hematoma. Muscle hematoma due to vertebral fracture can present radiological findings similar to an abscess. A characteristic “vertebral body cleft continuity sign” might be useful for differentiating between hematoma and abscess.
Collapse
Affiliation(s)
- Satoshi Yoshikawa
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, 9-7 Jurakumawari-Matsushita-cho, Nakagyo-ku, Kyoto 604-8401, Japan
| | - Ryo Kitamura
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, 9-7 Jurakumawari-Matsushita-cho, Nakagyo-ku, Kyoto 604-8401, Japan
| | - Takeshi Ueda
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, 9-7 Jurakumawari-Matsushita-cho, Nakagyo-ku, Kyoto 604-8401, Japan
| |
Collapse
|
26
|
Yamada Y, Kinoshita C, Nakagawa H. Lumbar vertebral osteomyelitis and psoas abscess caused by Actinomyces israelii after an operation under general anesthesia in a patient with end-stage renal disease: a case report. J Med Case Rep 2019; 13:351. [PMID: 31775881 PMCID: PMC6881975 DOI: 10.1186/s13256-019-2261-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/16/2019] [Indexed: 11/21/2022] Open
Abstract
Background Actinomycosis is a chronic, slowly progressive infection caused by the Actinomyces species. Lumbar vertebral involvement of Actinomyces israelii is extremely rare; this is the first case report of lumbar vertebral osteomyelitis and psoas abscess caused by Actinomyces israelii after an operation under general anesthesia. Case presentation A 66-year-old Japanese man with end-stage renal disease was admitted to our hospital for an operation for cervical canal stenosis. After the operation under general anesthesia, during which tracheal intubation and nasogastric tube insertion were performed, he developed low back pain. During a second hospitalization, computed tomography revealed osteolysis of the lumbar endplates of L2 and L3, swelling of the intervertebral disk of L2/L3, and swelling of the left psoas major muscle. Percutaneous drainage of the intervertebral disc was performed, and the culture of the aspirate grew Actinomyces israelii. Based on the susceptibility, ampicillin was administered but his condition did not improve. We changed the antibiotics to ampicillin-sulbactam for coverage of unidentified oral commensals, and his symptoms and signs finally improved. Conclusion Our patient’s long-term end-stage renal disease had made the oral and gastrointestinal mucosal barriers very fragile. Under these conditions, even mildly invasive procedures such as tracheal intubation and nasogastric tube insertion could be the cause of infectious complication by oral commensals, including Actinomyces.
Collapse
Affiliation(s)
- Yutaka Yamada
- Department of General Internal Medicine, Kyoto Min-Iren Chuo Hospital, 16-1 Nishinokyo Kasugacho, Nakagyo Ward, Kyoto, 604-8453, Japan.
| | - Chiharu Kinoshita
- Department of Nephrology, Kyoto Min-Iren Chuo Hospital, Kyoto, Japan
| | - Hirokazu Nakagawa
- Department of Orthopedics, Kyoto Min-Iren Chuo Hospital, Kyoto, Japan
| |
Collapse
|
27
|
Gao D, Medina MG, Alameer E, Nitz J, Tsoraides S. A case report on delayed diagnosis of perforated Crohn's disease with recurrent intra- psoas abscess requiring omental patch. Int J Surg Case Rep 2019; 65:325-328. [PMID: 31770708 PMCID: PMC6879988 DOI: 10.1016/j.ijscr.2019.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/07/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Intra-abdominal abscesses associated with Crohn's disease (CD) can rarely occur in the psoas muscle. An intra-psoas abscess is prone to misdiagnosis because its location mimics other diseases, like appendicitis and diverticulitis [1]. PRESENTATION OF CASE We present the case of a 25-year-old female with an 11-year history of CD, previously well-controlled on Remicade, who presented with right lower quadrant (RLQ) pain and CT findings of a right psoas abscess initially attributed to perforated appendicitis. Two percutaneous drainages pre-ileocecectomy, laparoscopic ileocecectomy, three percutaneous drainages post-ileocolectomy, and evidence of a recurrent abscess prompted diagnostic laparoscopy. The abscess was unroofed and debrided. A flap of omentum was used to fill the abscess cavity. A comprehensive literature search was performed using the terms 'Crohn's abscess', 'intra-psoas abscess', and 'omental patches' in Medline and on PubMed. DISCUSSION We attribute the abscess' recurrence to possible epithelialization of the abscess cavity. Intra-psoas abscesses, albeit rare, are a known manifestation of CD. Percutaneous drainage is the initial standard of care, although diagnosis can be difficult given its association with several diseases, which can delay definitive treatment. We summarize a recently proposed and agreed upon treatment scheme for the management of the Crohn's patient with an abdominal abscess. We also propose the novel technique of omental packing in abscess management. CONCLUSION Clinician awareness must be heightened for perforating CD in the setting of abscess refractory to either multiple drainage procedures, although care should be taken to individualize treatment to each CD patient who presents with an abdominal abscess.
Collapse
Affiliation(s)
- David Gao
- Department of Surgery, University of Illinois College of Medicine Peoria, 624 NE Glen Oak, Peoria, IL 61603, United States
| | - Melissa G Medina
- Department of Surgery, University of Illinois College of Medicine Peoria, 624 NE Glen Oak, Peoria, IL 61603, United States
| | - Ehab Alameer
- Department of Surgery, University of Illinois College of Medicine Peoria, 624 NE Glen Oak, Peoria, IL 61603, United States
| | - Jonathan Nitz
- Department of Surgery, University of Illinois College of Medicine Peoria, 624 NE Glen Oak, Peoria, IL 61603, United States.
| | - Steven Tsoraides
- Department of Surgery, University of Illinois College of Medicine Peoria, 624 NE Glen Oak, Peoria, IL 61603, United States
| |
Collapse
|
28
|
Alvarado MU, Colindres CA, Pinto LJ, Padilla CG, Reyes CE. Secondary psoas abscess after an open cholecystectomy and a common bile duct exploration. Int J Surg Case Rep 2019; 63:53-55. [PMID: 31563664 PMCID: PMC6796607 DOI: 10.1016/j.ijscr.2019.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/02/2022] Open
Abstract
Psoas abscesses are rare, with a worldwide incidence of only 12 new cases per year. Kocher maneuver increases risk of perforation and consequent inoculation of the retroperitoneal space with microorganisms. External contamination may occur either through use of contaminated instruments or inadequate asepsis of the surgical area.
Background A psoas abscess presents a diagnostic challenge, due to its rarity, non-specific clinical manifestations and wide range of etiologies. Case report We describe a case of a secondary psoas abscess containing Staphylococus aureus following open cholecystectomy and common bile duct exploration in a woman who had no history or evidence of comorbidity. Conclusions Two possible causes of this abscess are performance of the Kocher maneuver during the surgical procedure and external contamination. This case adds cholecystectomy and cholecystitis to the list of known causes of psoas abscesses.
Collapse
Affiliation(s)
| | | | - Luis José Pinto
- Emergency Department, Hospital San Francisco, Juticalpa, Honduras.
| | - Cintia G Padilla
- Pediatrics Department, Hospital Santa Teresa, Universidad Nacional Autonoma de Honduras, Comayagua, Comayagua, Colonia Lopez, Honduras.
| | - Carlos E Reyes
- Surgery Deparment, Hospital Escuela Universitario, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Francisco Morazán, Colonia Kennedy primera entrada, Honduras.
| |
Collapse
|
29
|
Kim J, Lee JH, Kim SW, Oh JK, Kim YW, Kim TH. Outcomes of additional instrumentation in elderly patients with pyogenic vertebral osteomyelitis and previous spinal instrumentation. Spine J 2019; 19:1498-1511. [PMID: 31108235 DOI: 10.1016/j.spinee.2019.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In patients with pyogenic vertebral osteomyelitis (PVO) and previous instrumentation requiring surgical treatment, a decision must be made between a less-invasive noninstrumented surgery, including retaining the previous instrumentation, or a more invasive additional instrumented surgery involving the complete removal of the infected tissue and firm restabilization. PURPOSE To evaluate the clinical outcomes of using additional instrumentation in patients with PVO and previous instrumentation and determine the significant risk factors related to recurrent infection. STUDY DESIGN/SETTING Retrospective cohort study (case control study). PATIENT SAMPLE PVO patients with previous instrumentation. OUTCOME MEASURES Recurrence of PVO and mortality. METHODS Patients were divided into two groups (instrumented or noninstrumented) according to the presence or absence of additional instrumentation. The baseline characteristics, infection profile, and treatment outcomes were compared between the two groups, and a multivariate logistic regression analysis was performed to identify the risk factors for infection recurrence. RESULTS A total of 187 postoperative patients with PVO and previous spinal instrumentation were included. There were no significant differences in the baseline characteristics except the presence of a titanium cage. Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality compared with noninstrumented surgery despite a larger number of involved vertebral levels and greater incidence of epidural abscesses. However, instrumented patients with PVO and previous instrumentation who experienced infection recurrence had worse clinical outcomes than those of the noninstrumented patients with PVO. Severe medical comorbidities, the presence of a psoas abscess, and methicillin-resistant Staphylococcus aureus infection were associated with a higher risk of infection recurrence. CONCLUSIONS Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality to those who underwent noninstrumented surgery despite a larger number of involved vertebral levels and an increased frequency of epidural abscesses.
Collapse
Affiliation(s)
- Jihye Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul 05355, Republic of Korea
| | - Jeong Hwan Lee
- Department of Orthopedics, Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068, Republic of Korea
| | - Seok Woo Kim
- Department of Orthopedics, Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068, Republic of Korea
| | - Jae-Keun Oh
- Department of Orthopedics, Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068, Republic of Korea
| | - Young-Woo Kim
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong-si, Gyeonggi-do 18450, Republic of Korea
| | - Tae-Hwan Kim
- Department of Orthopedics, Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068, Republic of Korea.
| |
Collapse
|
30
|
Iida K, Yoshikane K, Tono O, Tarukado K, Harimaya K. The effectiveness of a percutaneous endoscopic approach in a patient with psoas and epidural abscess accompanied by pyogenic spondylitis: a case report. J Med Case Rep 2019; 13:253. [PMID: 31412911 PMCID: PMC6694662 DOI: 10.1186/s13256-019-2193-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 07/08/2019] [Indexed: 11/25/2022] Open
Abstract
Background Psoas or epidural abscesses are often accompanied by pyogenic spondylitis and require drainage. Posterolateral percutaneous endoscopic techniques are usually used for hernia discectomy, but this approach is also useful in some cases of psoas or lumbar ventral epidural abscess. We here report a case of psoas and epidural abscesses accompanied by pyogenic spondylitis that was successfully treated by percutaneous endoscopic drainage. Case presentation Our patient was a 57-year-old Japanese woman who had been receiving chemotherapy for inflammatory breast cancer and who became unable to walk due to lower back and left leg pain. She was transported as an emergency to another hospital. Magnetic resonance imaging revealed psoas and epidural abscesses accompanied by pyogenic spondylitis, and methicillin-resistant Staphylococcus aureus was detected in a blood culture. Drainage of the psoas abscess was performed under echo guidance, but was not effective, and she was transferred to our institution. We performed percutaneous endoscopic drainage for the psoas and epidural abscesses. Immediate pain relief was achieved and the inflammatory reaction subsided after 8 weeks of antibiotic therapy with daptomycin. Conclusions Percutaneous endoscopy allowed us to approach the psoas and epidural abscesses directly, enabling the immediate drainage of the abscesses with less burden on the patient.
Collapse
Affiliation(s)
- Keiichiro Iida
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan.
| | - Koichi Yoshikane
- Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Osamu Tono
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan
| | - Kiyoshi Tarukado
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan
| |
Collapse
|
31
|
Stone AH, King PJ. Simultaneous combined retroperitoneal and posterior hip approach for the treatment of ilio psoas abscess with extension to a metal-on-metal prosthetic hip joint. Arthroplast Today 2019; 5:269-275. [PMID: 31516963 PMCID: PMC6728528 DOI: 10.1016/j.artd.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/27/2022] Open
Abstract
Iliopsoas abscess is an uncommon entity that has only rarely been associated with periprosthetic hip infection; to our knowledge, these are the first reported cases in patients with metal-on-metal (MoM) hip arthroplasty. We report 2 cases of iliopsoas abscess and concomitant periprosthetic hip infection in patients with a history of MoM hip arthroplasty. Case 1 presented with an acute infection 18 months after revision total hip arthroplasty (THA) for instability and adverse local tissue reaction after MoM THA. Case 2 presented with an acute infection in a previously well-functioning MoM THA. Both cases were treated with combined hip and retroperitoneal approaches and required more aggressive and longer treatment than is typical for periprosthetic infection, but ultimately resulted in successful revision THAs. We outline the treatment of these 2 patients and review the previously reported literature.
Collapse
Affiliation(s)
- Andrea H Stone
- Department of Surgical Research, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Paul J King
- Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, MD, USA
| |
Collapse
|
32
|
Chaudhary H, Al-Sadawi M, Dubson I, Jayarangaiah A, McFarlane SI. Psoas Abscess with Septic Arthritis of the Hip in a Patient with Chronic Back Pain. Am J Med Case Rep 2018; 6:224-5. [PMID: 30740521 DOI: 10.12691/ajmcr-6-11-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Psoas abscess is a rare clinical entity that requires early diagnosis and timely intervention to avoid serious complications of the disease. We report a case of psoas abscess that presented initially as low back pain then complicated with septic arthritis. We discuss the clinical diagnosis, intervention and follow up of the case along with review of the literature. This important clinical entity that generally presents with vague signs and symptoms leads to a delay in diagnosis and timely intervention.
Collapse
|
33
|
Nakamura T, Morimoto T, Katsube K, Yamamori Y, Mashino J, Kikuchi K. Clinical characteristics of pyogenic spondylitis and psoas abscess at a tertiary care hospital: a retrospective cohort study. J Orthop Surg Res 2018; 13:302. [PMID: 30486831 PMCID: PMC6264034 DOI: 10.1186/s13018-018-1005-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 11/15/2018] [Indexed: 12/04/2022] Open
Abstract
Background Psoas abscess and pyogenic spondylitis are intractable diseases that require long-term treatment, but the clinical characteristics and causative organisms have not been fully investigated. Herein, we describe the clinical characteristics of these diseases and evaluate the factors associated with in-hospital mortality and the presence of gram-negative rods as causative microorganisms. Methods All patients diagnosed with pyogenic spondylitis or psoas abscesses at a tertiary hospital were included. We retrieved the clinical data (age, sex, outcome, length of hospital stay, disease, bacteria, medication, comorbidities, and treatment status), vital signs (blood pressure, heart rate, and body temperature), and laboratory test results (blood cell count, liver function, renal function, electrolytes, blood sugar, and C-reactive protein) of all patients. The outcomes were in-hospital deaths and positive cultures of gram-negative rods. Results We analyzed 126 patients consisting of 69 (55%) men with a population mean age of 72 years. Seventy-two patients had pyogenic spondylitis and 54 had psoas abscesses. Eleven patients (8.3%) died during admission. The causative bacteria were gram-positive cocci in 63 patients (50%) and gram-negative bacteria in 19 patients (15%). The multivariate logistic model showed that blood urea nitrogen (BUN) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.06) and cardiovascular diseases (OR 7.02, 95% CI 1.55–31.8) were associated with in-hospital mortality. Platelets less than 150,000/μL (OR 3.14, 95% CI 1.02–9.65) and higher aspartic aminotransferase (OR 1.02, 95% CI 1.00–1.03) were associated with gram-negative rods. Conclusions Patients with suspected psoas abscesses or pyogenic spondylitis having a high BUN level and a history of cardiovascular diseases have a higher risk of mortality.
Collapse
Affiliation(s)
- Tsukasa Nakamura
- Department of Infectious Diseases, Shimane Prefectural Central Hospital, Izumo, Japan.,Clinical Education and Research Center, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Takeshi Morimoto
- Clinical Education and Research Center, Shimane Prefectural Central Hospital, Izumo, Japan. .,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Kosuke Katsube
- Department of Orthopedics, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Yuji Yamamori
- Department of Emergency Medicine, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Junji Mashino
- Clinical Education and Research Center, Shimane Prefectural Central Hospital, Izumo, Japan.,Department of General Medicine, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Kiyoshi Kikuchi
- Department of Pediatrics, Shimane Prefectural Central Hospital, Izumo, Japan
| |
Collapse
|
34
|
Lai Z, Shi S, Fei J, Han G, Hu S. A comparative study to evaluate the feasibility of preoperative percutaneous catheter drainage for the treatment of lumbar spinal tuberculosis with psoas abscess. J Orthop Surg Res 2018; 13:290. [PMID: 30454001 PMCID: PMC6245803 DOI: 10.1186/s13018-018-0993-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background Spinal tuberculosis is a frequent cause of psoas abscess (PA), and PA largely negates the efficacy of antituberculosis therapy. This study aimed to investigate the clinical outcome of preoperative percutaneous catheter drainage (PCD) in patients with lumbar spinal tuberculosis and PA. Methods Between January 2015 and January 2017, 72 patients with lumbar spinal tuberculosis with PA were assigned to group A (preoperative PCD) and group B (n = 36 per group). All patients received posterior pedicle screw fixation and anterior focal debridement and fusion. Data on intraoperative blood loss, the duration of the surgery, and the length of the anterior incision were recorded, as well as the postoperative anal exhaust time, visual analogue scale (VAS), Cobb angle, lumbar vertebra function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and sinus tract formation. Results Sixty-eight patients were followed up for an average time of 13 months (range 6–21 months). Until the final follow-up, no mixed infections, recurrence of tuberculosis, pedicle screw loosening, or screw pullout had occurred. There were significant between-group differences in blood loss, surgery duration, anterior incisional length, postoperative anal exhaust time, and sinus tract formation. As compared with group B, the ESR and CRP levels of the patients in group A were markedly improved following 3 weeks of antituberculosis therapy and 1 week postsurgery. Conclusion Preoperative PCD helps to increase the efficacy of antituberculosis therapy prior to surgery, reduce surgical trauma, and avoid postoperative complications, making it a safe and feasible treatment option for lumbar spinal tuberculosis with PA.
Collapse
Affiliation(s)
- Zhen Lai
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Shiyuan Shi
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China.
| | - Jun Fei
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Guihe Han
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Shengping Hu
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| |
Collapse
|
35
|
Fataki CM, Kasmy Z, Sahrourdi S, Raghani A, Rhars A, Frikh M, Chadli M, Lemnouar A, Chaari J, Elouennass M. [Primary tuberculous abscess and pyogenic psoas abscess: an uncommon association]. Pan Afr Med J 2018; 28:280. [PMID: 30402201 PMCID: PMC6211819 DOI: 10.11604/pamj.2017.28.280.13796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/25/2017] [Indexed: 11/11/2022] Open
Abstract
Les abcès du psoas représentent 5 à 10% des suppurations abdominales. Elles peuvent être primaires ou secondaires. Les abcès primaires polymicrobiens du psoas, notamment tuberculeux et à pyogène, n’ont jamais été rapportés. Nous en décrivons un cas chez un patient de 35 ans, sans antécédents pathologiques particuliers, admis pour la prise en charge des douleurs de la fosse lombaire droite associée à une fièvre à 40°C dont la symptomatologie remonte à 5 mois auparavant mais sans fièvre. La tomodensitométrie abdominale a montré un abcès des muscles psoas transverse et oblique externe droite étendu au retro-péritoine infiltrant la paroi thoraco-abdominale. L’analyse cytobactériologique du pus retrouve une culture riche et monomorphe d’Escherichia coli sauvage. La recherche du Complexe Mycobaterium tuberculosiseffectuée systématiquement sur ce genre de prélèvement était positive après PCR tandis que l’examen direct après coloration de Ziehl Nelseen était négatif. La culture sur milieu solide Lowenstein-Jensen s’est positivée après un mois d’incubation. Le patient a bien évolué sous quadrithérapie antibacillaire et ceftriaxone. A travers ce cas, il en découle qu’une origine tuberculeuse doit être recherchée systématiquement en zone d’endémie devant tout abcès du psoas à évolution chronique, récidivant ou ne répondant pas aux antibiotiques.
Collapse
Affiliation(s)
- Christelle Mboyo Fataki
- Laboratoire de Bactériologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Zohour Kasmy
- Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc.,Service de Médecine Interne, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Sara Sahrourdi
- Laboratoire de Bactériologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Abdeljalil Raghani
- Laboratoire de Bactériologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Amal Rhars
- Laboratoire de Bactériologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mohamed Frikh
- Laboratoire de Bactériologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mariam Chadli
- Laboratoire de Bactériologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Abdelhay Lemnouar
- Laboratoire de Bactériologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Jilali Chaari
- Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc.,Service de Médecine Interne, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Mostafa Elouennass
- Laboratoire de Bactériologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| |
Collapse
|
36
|
Pawar A, Manwani C, Thete R, Bapat M, Peshettiwar V, Gore S. Endoscopic Decompression Can Be Effective for Diagnosing and Treating Tubercular Spondylodiskitis with Early Epidural Spinal Compression: A Retrospective Study of 18 Cases. Asian Spine J 2018; 12:803-809. [PMID: 30213161 PMCID: PMC6147883 DOI: 10.31616/asj.2018.12.5.803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/09/2018] [Indexed: 12/05/2022] Open
Abstract
Study Design Retrospective study. Purpose In this study, we describe an endoscopic method of effectively treating tubercular lumbar spondylodiskitis with early onset epidural spinal cord compression in the lumbar spine on magnetic resonance imaging (MRI). Overview of Literature Percutaneous aspiration and biopsy of spondylodiskitis under ultrasonography and computer tomography scan invariably provides an inadequate diagnosis. Methods From May 2015 to May 2017, 18 patients presented with intractable back pain and were diagnosed with tubercular spondylodiskitis on MRI; these patients were enrolled in this study. The goal was to confirm the pathogen on biopsy, drain the abscess, and perform debridement. Chemotherapy was started after histologic diagnosis, and data collected included blood cell counts, erythrocyte sedimentation rate, C-reactive protein, and repeat MRI after 3 months. Results Mean duration of surgery was 52 minutes. Mean follow-up was 17 months. The average preoperative Visual Analog Scale score of 8 (range, 6–10) decreased to 3 (range, 1–8) postoperatively. Tubercular spondylodiskitis was observed in 14 cases; two cases were pyogenic, and the biopsy was inconclusive in two cases. After adequate chemotherapy, no recurrences were noted. Conclusions We hereby conclude that endoscopic biopsy and drainage can provide a better diagnosis and decrease pain in a predictable manner.
Collapse
Affiliation(s)
- Abhijit Pawar
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Chirag Manwani
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Raghavendra Thete
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Mihir Bapat
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Vishal Peshettiwar
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Satishchandra Gore
- Center for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| |
Collapse
|
37
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
38
|
Kramer L, Geib V, Evison J, Altpeter E, Basedow J, Brügger J. Tuberculous sacroiliitis with secondary psoas abscess in an older patient: a case report. J Med Case Rep 2018; 12:237. [PMID: 30119703 PMCID: PMC6098574 DOI: 10.1186/s13256-018-1754-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/22/2018] [Indexed: 11/11/2022] Open
Abstract
Background Tuberculosis is the leading infectious cause of death worldwide. Among native Swiss people, tuberculosis is more common in older people than in younger people. Approximately 25–30% of reported cases of tuberculosis are purely extrapulmonary; skeletal tuberculosis is reported in 3–5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of tuberculous sacroiliitis with secondary psoas abscess, as this clinical picture is very rare. Case presentation A magnetic resonance imaging scan of an 85-year-old (Swiss-German) Caucasian woman with chronic left-sided hip pain and limitation of hip joint movement showed a progressive destruction of her sacroiliac joint and a large collection in her left iliopsoas muscle. Drainage of the abscess revealed pus; a polymerase chain reaction assay was positive for Mycobacterium tuberculosis complex. Tuberculous sacroiliitis with secondary iliopsoas abscess was diagnosed 9 months after the start of the symptoms. Combination treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. Conclusions Sacroiliitis with secondary psoas abscess is an unusual cause of hip pain and is likely to be overlooked since joint pain of the lower extremity and lumbar pain are some of the most common complaints in older individuals. A high level of suspicion and invasive diagnostic procedures are needed for timely diagnosis of tuberculous sacroiliitis not only in immunocompromised patients living in or originating from endemic areas.
Collapse
Affiliation(s)
- Luisa Kramer
- Department of Internal Medicine, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Vanessa Geib
- Department of Internal Medicine, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland
| | - John Evison
- Department of Infectious Disease, Lindenhof Hospital, Bremgartenstrasse 117, 3001, Bern, Switzerland
| | - Ekkehardt Altpeter
- Federal Office of Public Health, Schwarzenburgstrasse 157, 3003, Bern, Switzerland
| | - Jasmin Basedow
- Department of Radiology, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Jan Brügger
- Department of Internal Medicine, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland.
| |
Collapse
|
39
|
Nishimura Y, Otsuka F. Psoas abscess secondary to paravertebral inflammation. IDCases 2018; 13:e00435. [PMID: 30128291 PMCID: PMC6092524 DOI: 10.1016/j.idcr.2018.e00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/04/2018] [Accepted: 08/04/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yoshito Nishimura
- Corresponding author at: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | | |
Collapse
|
40
|
Abstract
Introduction Iliopsoas abscess (IPA) has varied clinical symptomatology and various clinical disorders may mimic it. Tuberculosis of spine is the most common source of secondary IPA in the developing countries. However, IPA may be rarely caused by colon cancer which is the most common gastrointestinal malignancy. A mixed culture gives an indication of gastrointestinal or genitourinary etiology. We present here, a rare case of an 86-year-old patient with IPA secondary to adenocarcinoma of colon. Case Report An 86-year-old female presented with pain in the right thigh in February 2014. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen confirmed the clinical suspicion of right IPA which was drained surgically. Intraoperatively, mucinous material was noted, emerging from a small opening in a rounded structure located lateral to the psoas muscle, which could not be identified. On post-operative day 2, the right flank swelling recurred. Culture reports showed a polymicrobial infection with viridans group Streptococci and Pseudomonas aeruginosa. The abscess was re-explored and biopsy of the opening was taken. Histopathology of the tissue sample revealed metastatic cells of a mucin-secreting adenocarcinoma that had infiltrated the psoas muscle with a secondary pyogenic abscess. On reviewing the CT scan, there was a suspicion that the abscess was communicating with a tumor in the colon. No further active intervention was done for the tumor in view of advanced age and stage of tumor. The patient had significant pain relief and was able to resume walking. The infection resolved with 6 weeks of oral linezolid and ciprofloxacin. The patient died 8 months later secondary to metastasis. Conclusion Although the diagnosis of IPA does not pose problems, diagnosing secondary IPA requires a high index of clinical suspicion. A Gram-negative culture must raise the suspicion of gastrointestinal or genitourinary pathology. Colon carcinoma, although extremely rare, can lead to secondary IPA. CT and MRI though extremely useful, may not pick up the pathology and a definitive diagnosis of colon neoplasia perforating into the psoas muscle may be evident only intraoperatively. Atypical presentation may delay the diagnosis of colon cancer and subsequently result in higher morbidity and mortality.
Collapse
Affiliation(s)
- Aditya Menon
- Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
| | - Vikas M Agashe
- Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
| | - Mithun S Jakkan
- Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
| |
Collapse
|
41
|
Abstract
PURPOSE To describe the outcomes of 7 cases of psoas abscess concurrent with septic arthritis of the hip treated by hip arthroscopy alone. METHODS We retrospectively collected the data of patients who underwent arthroscopic drainage of psoas abscess concurrent with septic arthritis of the hip. Arthroscopic debridement was performed in both the central and peripheral hip joint compartments. In all cases, the iliopsoas compartment was accessed from the peripheral compartment through an anterior capsulotomy without limb traction. After debridement and drainage of the iliopsoas compartment, a suction drain tube was placed in the iliopsoas compartment through an enlarged anterior capsulotomy and another tube in the peripheral compartment. Postoperative intravenous antibiotics were administered on the basis of culture results; in cases with no positive culture, empirical antibiotics were administered for 4 to 6 weeks after surgery. RESULTS 7 patients underwent arthroscopic debridement and drainage for a psoas abscess concurrent with hip joint septic arthritis. Laboratory tests were normalized within 4 weeks after hip arthroscopy in all patients. At a median follow-up of 16 months (range, 13-30 months) after surgery, infection recurrence was absent in all patients. CONCLUSIONS Arthroscopic debridement alone could be an effective treatment alternative to open surgery for psoas abscess concurrent with hip joint septic arthritis.
Collapse
|
42
|
Atif M, Malik AT, Noordin S. Psoas abscess masquerading as a prosthetic hip infection: A case report. Int J Surg Case Rep 2017; 42:17-19. [PMID: 29202351 PMCID: PMC5723361 DOI: 10.1016/j.ijscr.2017.11.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022] Open
Abstract
Psoas muscle forms a conduit for spread of infection from upper part of body to hip joint. In the presence of prosthetic hip, psoas abscess may present as prosthetic joint infection. Treatment depends on early detection of causative organisms and their eradication.
Introduction Psoas abscess is an unusual condition and is defined as a collection of pus in the iliopsoas compartment. Due to the unique anatomy of psoas muscle it forms a conduit for spread of infection from upper part of body to hip joint in neglected cases. Case presentation A 67 year old lady presented with left groin pain for three weeks. She underwent an uncemented unipolar hemiarthoplasty eight years back. Currently, she developed fever and was unable to do any active left hip range of motion. Passive motion of the left hip was restricted to 30° flexion, no internal rotation, 5° external rotation, and 10° abduction. Lab workup showed raised serum infective markers and radiographs of pelvis were normal with no evidence of any radiolucency. Ultrasound guided aspiration of left hip joint showed E coli. Arthrotomy revealed clear fluid in hip joint but pus was drained at psoas insertion. Later on, culture reported presence of E. coli and biopsy confirmed psoas abscess. Postoperatively CT scan abdomen showed pyelonephritis. Antibiotics were given for three months. Twenty months later, she remains asymptomatic without evidence of infection with normal gait. Discussion Psoas abscess is a rare clinical entity that may mimic symptoms of a primary prosthetic hip infection. Treatment outcomes are directly related to early detection with adequate dissection of the psoas muscle up to sites of attachment and complete eradication of infection. Conclusion This case highlights importance of thorough initial clinical examination, lab workup and radiological assessment to rule out rare causes of hip joint pain.
Collapse
Affiliation(s)
- Muhammad Atif
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Azeem Tariq Malik
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
| | - Shahryar Noordin
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
43
|
Wan WY, Mughal A, Ward K. Bilateral psoas abscess caused by Janibacter terrae, an unusual condition and organism resulting in laboratory and management conundrums. Acta Clin Belg 2017; 72:336-339. [PMID: 27758139 DOI: 10.1080/17843286.2016.1245937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Psoas abscess is commonly regarded as an unusual cause for back pains and usually associated with significant risk factors or co-morbidities. We describe the clinical presentation and findings of a young male Caucasian with bilateral psoas abscesses caused by an unusual organism, Janibacter terrae (an environmental organism) not previously described in literature and the challenges faced in managing this infection. There are very few case reports of this organism causing opportunistic infections, all reported bacteraemia mainly in patients with significant co-morbidities. This case highlights the importance of psoas abscess as a differential diagnosis in patients presenting with back pain and the potential for this organism to cause abscesses in healthy individuals which was difficult to identify using conventional laboratory methods. Management of this infection was challenging and there is limited experience with antimicrobial treatment for this organism.
Collapse
Affiliation(s)
- Wei Yee Wan
- Microbiology Department, Cwm Taf University Health Board, Wales, UK
| | - Ahsan Mughal
- Respiratory Medicine, Cwm Taf University Health Board, Wales, UK
| | - Kelly Ward
- Microbiology Department, Cwm Taf University Health Board, Wales, UK
| |
Collapse
|
44
|
Mahapatra S, Ramakrishna P, Gupta B, Shetty N, Para MA. Management of Iatrogenic Injury to the Inferior Vena Cava and Right Common Iliac Artery for Drainage of Psoas Abscess. Aorta (Stamford) 2017; 5:64-67. [PMID: 28868319 DOI: 10.12945/j.aorta.2017.16.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 03/12/2017] [Indexed: 11/18/2022]
Abstract
Iatrogenic simultaneous inferior vena cava (IVC) and iliac vessel injury is a rare entity. Ligation of the IVC in a life-threatening situation is well reported in the literature. Our case demonstrates that such a clinical situation requires optimization of fluid volume and management of sequelae such as deep vein thrombosis.
Collapse
Affiliation(s)
- Sandeep Mahapatra
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Pinjala Ramakrishna
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Bhumika Gupta
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Naren Shetty
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Muneer Ahmad Para
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| |
Collapse
|
45
|
Kim KS, Kim YK, Kim SS, Shim SM, Cho HJ. Cerebrospinal fluid infection after lumbar nerve root steroid injection: a case report. Korean J Anesthesiol 2017; 70:90-94. [PMID: 28184274 PMCID: PMC5296395 DOI: 10.4097/kjae.2017.70.1.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/27/2016] [Accepted: 06/30/2016] [Indexed: 11/10/2022] Open
Abstract
A 45-year-old woman was admitted due to severe headache and neck stiffness. She had visited a local clinic for back pain and received a lumbar nerve root steroid injection 10 days before admission. Computed tomography and magnetic resonance imaging showed psoas abscess, pneumocephalus, and subdural hygroma. She was diagnosed with psoas abscess and meningitis. The abscess and external ventricle were drained, and antibiotics were administered. Unfortunately, the patient died on hospital day 19 due to diffuse leptomeningitis. Lumbar nerve root steroid injections are commonly used to control back pain. Vigilance to "red flag signs" and a rapid diagnosis can prevent lethal outcomes produced by rare and unexpected complications related to infection. Here, we report a case of fatal meningitis after infection of the cerebrospinal fluid following a lumbar nerve root steroid injection.
Collapse
Affiliation(s)
- Kwan-Sub Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Young-Ki Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Seong-Su Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sung Min Shim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hae Jun Cho
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Providence, RI, USA
| |
Collapse
|
46
|
Abstract
Introduction: Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections. Case report: We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip. He then developed an infected right thigh haematoma, which also formed a discharging sinus connecting to the right hip post-drainage. He was treated with bilateral two-stage revision total hip arthroplasties and multiple courses of prolonged antibacterial therapy. Both abscesses and hip joints cultured the same species of multi-sensitive Staphylococcus aureus. The causal link between the psoas abscess and the prosthetic hip infections is discussed, as well as the investigation and management. Conclusion: We recommend routine exploration of the iliopsoas bursa when revision of an infected total hip arthroplasty is performed to rule out intrapelvic spread of the infection [3]. There should be high index of suspicion of prosthetic hip infection in patients presenting with Psoas abscess and vice versa. A CT scan might be warranted to rule out concomitant infection in both these patients.
Collapse
Affiliation(s)
| | - Riaz J K Khan
- Department of Computer Science and Engineering, Curtin University of Technology, Perth, Australia; The University of Notre Dame, Perth, Australia; The Joint Studio, Perth, Australia
| | - Cynthia Tan
- Hollywood Private Hospital, Perth, Australia
| | - Clayton Golledge
- Department of Infectious Diseases, Sir Charles Gairdner Hospital, Perth, Australia
| |
Collapse
|
47
|
Yoon S, Jeong E, Lázaro HA. Multidisciplinary Approach to an Extended Pressure Sore at the Lumbosacral Area. Arch Plast Surg 2016; 43:586-9. [PMID: 27896193 DOI: 10.5999/aps.2016.43.6.586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/20/2016] [Accepted: 09/28/2016] [Indexed: 11/26/2022] Open
Abstract
A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.
Collapse
|
48
|
Silva AM, Schmalbach LA. [ Psoas abscess and lumbar spine osteomyelitis: case report]. ARCH ARGENT PEDIATR 2016; 114:e333-7. [PMID: 27606657 DOI: 10.5546/aap.2016.e333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/09/2016] [Indexed: 11/12/2022]
Abstract
Psoas abscess is a common disease in children. It can have a nonspecific clinical presentation, insidious onset and sometimes fever. The most common type in children is the primary one; however, it can sometimes be of secondary origin and associated with severe infections such as osteomyelitis so a high index of suspicion is required to detect and treat it promptly. We present an unusual case of psoas abscess with infiltration of the vertebral body of L2 in a 14 year old male patient previously healthy with no history of trauma or fever on admission. X-ray and ultrasound were performed but the diagnosis was confirmed by magnetic resonance imaging of the lumbosacral spine. With positive blood cultures for methicillin-resistant Staphylococcus aureus he completed 2 weeks of intravenous antibiotic therapy and 4 weeks of oral antibiotic therapy with blood cultures negativization and resolution of symptoms.
Collapse
Affiliation(s)
- Ana M Silva
- Servicio de Pediatría. Hospital Central de Pediatría Dr. Claudio Zin, Malvinas Argentinas, Buenos Aires.
| | - Lauwence A Schmalbach
- Servicio de Ortopedia y Traumatología. Hospital Municipal de Trauma y Emergencias Dr. Federico Abete, Malvinas Argentinas, Buenos Aires
| |
Collapse
|
49
|
Miller ELC, Miller LFF, Carvalho JG, Marsillac A, Pires L, Babinski MA, Monteiro M. Psoas muscle abscess simulating acute appendicits: A case report. Int J Surg Case Rep 2016; 25:139-42. [PMID: 27372027 PMCID: PMC4929344 DOI: 10.1016/j.ijscr.2016.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Psoas abscess is a rare clinical entity with vague symptomatology. We report a psoas abscess that simulated symptoms of acute appendicitis. PRESENTATION OF CASE A twenty-five year old male presented pain irradiating to the right iliac fossa and lumbar region associated with thigh flexion. Laboratorial exams revealed leukocytosis with a neutrophil shift to the left. Abdominal Ultrasound showed significant intestinal distension and a small quantity of free fluid at the right iliac fossa. Laparotomy and an appendectomy were performed. During immediate post-operative, the patient evolved with worsening of the pain and the leukocytosis, therefore, we chose to maintain his antalgic posture. An abdominal Computerized Tomography scan with contrast was solicited, revealing an increase of the iliac and psoas muscles of the right side, and multiple bacterial focuses. A retroperitoneal access was performed and 300ml of purulent secretion was drained. Afterwards, we implanted a Penrose Drain. The patient had a good post-op evolution, being discharged 7days after the drainage. DISCUSSION The psoas muscle is a flexor of the thigh. Psoas abscess is an underdiagnosed condition, its main treatment is surgery associated with antibiotic therapy. CT scan seems to be the best choice of diagnostic image exam, although some authors prefer the nuclear magnetic resonance. CONCLUSION The psoas muscle abscess is uncommon and poorly characterized in its etiology, clinical associations, and its therapeutic approach. On the other hand, acute appendicitis is the most common abdominal emergency, with a 7% death rate, and surgery is its main treatment.
Collapse
Affiliation(s)
- Eugenio L C Miller
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| | - Luiz F F Miller
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| | - Jorge G Carvalho
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| | - Alexandre Marsillac
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| | - Lucas Pires
- Morphology Department, Biomedical Institute, Fluminense Federal University - Niterói, Rio de Janeiro, Brazil
| | - Marcio A Babinski
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil; Morphology Department, Biomedical Institute, Fluminense Federal University - Niterói, Rio de Janeiro, Brazil.
| | - Mauro Monteiro
- General Surgery Service of Municipal Hospital Moacyr Rodrigues do Carmo - Duque de Caxias, Rio de Janeiro, Brazil
| |
Collapse
|
50
|
Tamargo Delpón M, Demelo-Rodríguez P, Cano Ballesteros JC, Vela de la Cruz L. [ Psoas abscess caused by Staphylococcus lugdunensis]. Rev Argent Microbiol 2016; 48:119-21. [PMID: 27086257 DOI: 10.1016/j.ram.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/12/2015] [Accepted: 02/17/2016] [Indexed: 11/30/2022] Open
Abstract
Staphylococcus lugdunensis is a coagulase-negative staphylococcus of growing importance and atypical behavior. The infections caused by this microorganism are becoming more frequent, having a broader spectrum. Psoas abscesses caused by this germ are rare, with few cases reported in the literature. In this work, we present a case of a psoas abscess caused by S. lugdunensis in a patient suffering from diabetes mellitus and rheumatoid arthritis, which was treated with intravenous cloxacillin with a good outcome.
Collapse
Affiliation(s)
- María Tamargo Delpón
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Pablo Demelo-Rodríguez
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | - Laura Vela de la Cruz
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| |
Collapse
|