435. Iliopsoas Abscess in Egyptian Patients Presenting to Cairo University Hospitals

Abstract

BackgroundThe incidence of iliopsoas abscess (IPA) is rare but the frequency of this diagnosis has increased with the use of ultrasonography and computed tomography (CT). The vague presentation leads to delays in diagnosis and increases morbidity. Managing iliopsoas abscess is still forming a therapeutic challenge. The aim of this research was to study the features of iliopsoas abscess cases including the etiology and clinical presentation.MethodsPatients and Methods. all patients presented to the orthopedic outpatient clinic (Cairo university hospitals) by back pain were screened by plain X-ray and IPA was by ultrasonography (US). The confirmed patients were diagnosed as having psoas or iliopsoas collection and subjected to: full history taking, full laboratory workup, screening for tuberculosis, radiological studies and ultrasound-guided needle aspiration of the abscess. The aspirate samples were microbiologically tested by culture (aerobic, anaerobic and MGIT) and PCR technique. Follow-up US was done within 7 days from the first aspiration.ResultsThe outpatient clinic received 40 thousand back pain cases during a one-year study. Only 14 patients were diagnosed as IPA. The age ranged 19–65years (mean 37years) and 57% were male. 44.4% patients had primary IPA while 55.5% patients had secondary IPA. All patients had limping and flank pain, backache or both. Fever was common 90% of patients. Leukocytosis was found in 55.5% of patients, ESR was elevated and CRP was positive in all patients. Z.N stain for AFB was negative in all patients. Culture of aspirated fluid revealed S.aureus as the commonest organism (44% of cultures), then E.coli in (22% of cultures), Mycobacterial tuberculosis in 7% by MGIT culture and PCR. Other cultures were negative. All patients were treated by drainage and appropriate antibiotics. surgical intervention was needed in 22% patients. Recurrence occurred in only 1 patient with tuberculous iliopsoas abscess.ConclusionAlthough IPA is rare, the appropriate diagnosis by US is needed. S.aureus is the commonest pathogen but Mycobacterial tuberculosis could be a cause for recurrence.Disclosures All authors: No reported disclosures.