Case Of Iliopsoas Abscess Research Articles

Unusual presentation of primary iliopsoas abscess in an infant: a case report

Iliopsoas abscess (IPA) rarely occurs in newborns and infants. Symptom triad, including fever, inguinal swelling or discoloration, and limited lower limb movement, is observed in most cases. Herein, we report a case of unusual IPA in an 82-day-old boy who presented with fever as the only symptom. To our best knowledge, there have been no reports of infant IPA presenting without localizing signs. This report highlights the importance of a high degree of suspicion for timely diagnosis of infant IPA when an infant presents only with fever.

Presentation, management and outcomes of iliopsoas abscess at a University Teaching Hospital in Nepal.

Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnose due to vague clinical presentation. Early treatment with drainage and appropriate antibiotic therapy is necessary before sepsis sets in and become lethal. We conducted this study to evaluate clinical features, etiology, management strategies, and outcomes in patients with IPA from a University Teaching Hospital in Nepal. A retrospective analysis of 32 consecutive IPA cases managed at Tribhuvan University Teaching Hospital, Nepal for the period of January 2019 to February 2022 was carried out. The mean age was 42.5±19.1 years (range, 19-75 years) and the male: female ratio was 2.2:1. Two-thirds or more patients presented with fever, limp, fixed flexion deformity and/or low back pain. Ultrasonography (US) was diagnostic in 27 (84.4%) patients. Eighteen (56.3%) patients had primary IPAs, and 14 (43.7%) had secondary IPAs. Thirty (93.7%) patients were managed with US guided percutaneous drainage (PCD) and 2 (6.2%) patients underwent open surgical drainage. Drainage procedures were combined with antibiotics in all patients. Pus culture showed Staphylococcus aureus growing in the majority of cases (10 of 23, 43.5%). The hospital stay was longer in patients treated via surgical drainage compared to those who received PCD: 13days (range 12-14days) vs. 6.6days (range 4-13days), respectively. Recurrence of abscess was seen in 4 (12.5%) cases and all were successfully managed via a second PCD. There was no mortality. Varying clinical presentation of iliopsoas abscess demand a high index of suspicion for early diagnosis. Initial imaging modality in suspected case of IPA is US. US-guided PCD along with the appropriate antibiotics is a successful frontline treatment of IPAs with shorter hospital stay.

Iliopsoas abscess in patients receiving hemodialysis: a case series and a literature survey

BackgroundIliopsoas abscess is a relatively rare but serious infectious disease. Infectious disease is one of the major causes of death among patients receiving hemodialysis for end-stage renal disease (ESRD).Case presentationWe experienced three cases of iliopsoas abscess in patients receiving hemodialysis. The infection route was distinct in each case. A 79-year-old woman with ESRD due to autosomal dominant polycystic kidney disease exhibited bilateral iliopsoas abscesses caused by bacterial contamination during a lumbar epidural block procedure. A 60-year-old woman with ESRD due to diabetic nephropathy was diagnosed as having an iliopsoas abscess, caused by the direct invasion of bacteria from a renal abscess. A 78-year-old woman who started hemodialysis because of nephrosclerosis developed an iliopsoas abscess caused by the hematogenous spread of bacteria from emphysematous cystitis. All three cases were treated with antibiotics and/or percutaneous drainage. A survey of published reports suggested that iliopsoas abscess can be caused by infection through a variety of routes in hemodialysis patients.ConclusionBecause hemodialysis patients are at a high risk of infection because of their immunocompromised state, physicians should pay close attention to infection prevention. If iliopsoas abscess is suspected, examinations such as computed tomography, magnetic resonance imaging, and blood culture sampling should be conducted promptly, followed by appropriate treatment with antibiotics and/or drainage.

ILIOPSOAS ABSCESS: A CASE REPORT

Iliopsoas Abscess (IA) is a rare condition that predominantly affects young adults. It is a purulent collection that forms inside the iliopsoas muscle for several reasons. The primary form is due to hematogenous or lymphatic dissemination and the secondary form is the direct expansion of an infectious focus near the iliopsoas muscle. It is an insidious disease with a dragged clinical course, presenting with fever, thigh pain associated with abdominal and/or lower back pain, and there may be limitation of movements in the hip joint. The aim of this study is to demonstrate a case of IA in a 32-year-old female patient, admitted to the Palmas General Public Hospital (HGPP). After treatment, the patient evolved with symptomatic improvement and good clinical outcome.

Primary Iliopsoas Abscess in a Neonate

Iliopsoas abscess (IPA) is rare in children but exceptional in neonates. Fewer than 30 cases have been reported in literature. We present a case of 11-day neonate who was brought with left inguinal swelling along with significantly raised white cell count and positive C-reactive protein (CRP). Ultrasound and CT scan confirmed the diagnosis of IPA. Drainage of abscess was done by open method through extraperitoneal approach. Systemic antibiotics, according to culture and sensitivity, were given and the neonate recovered well and was sent home. IPA can be primary or secondary. Primary IPA is more common in neonates unlike adults, who have secondary IPA in majority of the cases. Primary IPA spreads by hematogenous route from distant occult source in the body. Staphylococcus aureus is the causative organism in most cases of primary IPA. Septic arthritis of hip joint is among important differentials. Ultrasound and CT scan are helpful in diagnosis in the presence of raised white cell count and positive CRP. Drainage of pus by open method and through extraperitoneal approach is preferred method although ultrasound-guided percutaneous drainage has also been done with successful outcome. In conclusion, neonatal IPA is extremely rare entity and can easily be overlooked. High index of suspicion is required for its diagnosis in cases where a neonate presents with groin swelling, limited or painful motion of leg and fever.

Iliopsoas Abscess Caused by Streptococcus pyogenes: A Case Report

There have been an increasing number of fatal infectious diseases caused by the so-called “flesh-eating bacteria”, one of which is Streptococcus pyogenes . So far, S. pyogenes has not been recognized as a cause of iliopsoas abscess. Here we report a rare case of iliopsoas abscess resulting from a S. pyogenes infection. A 64-year-old female with no past medical record was transferred to our hospital with a complaint of severe pain on the left side of her back. Upon arrival, cyanosis of the mouth and extremities was evident. An arterial blood gas analysis revealed metabolic acidosis. Laboratory analysis revealed liver and renal malfunction, as well as remarkably elevated C-reactive protein levels (29.18 mg/dL). Contrast-enhanced computed tomography revealed swelling of the left iliopsoas muscle. She was diagnosed with septicemia and multiple organ failure resulting from an iliopsoas abscess. She was admitted to the intensive care unit. Despite our efforts to treat her condition, including the administration of anti-bacterial drugs, a vasopressor drug, and dialysis treatment, her respiratory and cardiac conditions immediately worsened and she died 22 h after arrival. Blood culture obtained on arrival was positive for S. pyogenes . An autopsy performed after the consent of her family confirmed iliopsoas abscess on her left side. Microscopic findings revealed necrotizing fasciitis and myositis with the presence of Streptococcus inside the muscle. Thus, a diagnosis of necrotizing fasciitis and myositis caused by group A β-hemolytic Streptococcus was established. Little is known about iliopsoas abscess resulting from S. pyogenes infection. More awareness about this critical condition is needed, so that emergency clinicians can save patients from further progression of the disease. Clin Infect Immun. 2016;1(2):45-47 doi: https://doi.org/10.14740/cii15w

A Case of Iliopsoas Abscess and Cerebellum Abscess Caused by Misplacement of Central Venous Catheter

A Case of Iliopsoas Abscess and Cerebellum Abscess Caused by Misplacement of Central Venous Catheter

Iliopsoas Abscess in an Infant

Iliopsoas abscess (IPA) is uncommon in childhood and very rare in the neonate and infant. We present a case of IPA after an umbilical granuloma in an infant. A baby girl with a birth weight of 2,970 g was born at thirty-seven weeks and two days gestation by Caesarean Section. On the fourteenth day after birth, her umbilicus was wet and developed the granulomatous formation. At two months of age, she presented with right leg and groin swelling with mild bluish discoloration and without fever. She had poor movement of her right leg and showed apparent discomfort. Her umbilicus was dry and there was no granulomatous material. Ultrasonography and computed tomography demonstrated an iliopsoas abscess in the right position. Therefore, an extraperitoneal surgical drainage was performed, aspirating yellowish pus. Culture of the purulent material revealed Staphylococcus aureus. Systemic antibiotic therapy was continued for ten days. After three days of drainage, full-range motion of the right leg was gained, and then after eleven days, CT findings comfirmed the disappearance of the iliopsoas abscess. IPA is extremely rare and it is difficult to diagnose. However, it should be included in the differential diagnosis of an infant with poor leg movement and swelling of the groin to the femur.

Fungal iliopsoas abscess: A rare entity

Iliopsoas abscess is a rare entity that can present with unclear clinical features. The organisms responsible for infection are gram-negative germs (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Proteus mirabilis, Enterobacter spp.) and gram-positive cocci (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, ?-hemolytic streptococci, especially Streptococcus mitis). It can also be of tuberculous etiology. We present a rare case of Iliopsoas abscess caused by candida albicans.

Absceso del músculo iliopsoas: tratamiento y evolución en una serie de 35 pacientes

The present study was aimed at reviewing the iliopsoas abscess (IPA) from a contemporary perspective, on the basis of experience from two tertiary referral centres. We performed a retrospective analysis of 35 cases of IPA diagnosed between 1998 and 2009. Their clinical and microbiological features were recorded, as well as their long-term outcome according to the type of treatment: antibiotics alone (10 patients), or antibiotics plus percutaneous drainage or surgery (25 patients). Primary abscess occurred in 8 patients. The most frequent source of secondary abscesses was spondylodiscitis. The classic clinical triad (fever, pain and functional impairment) was present in 10 patients, with a median duration of symptoms before diagnosis of 12 days. Staphylococcus aureus was the most frequently isolated microorganism. At the end of a median follow-up of 454 days, the risk of poor outcome (related death and/or relapse) was higher among patients with diabetes mellitus (44.4% vs. 7.7%; P=.027), with no significant differences according to the therapeutic approach (20.0% in the group of antibiotics alone vs. 28.0% in the group with drainage or surgery). In our series, most cases of IPA were due to S. aureus and secondary to a skeletal source. Antibiotic therapy seems effective in the long-term, although diabetic patients had a higher risk of relapse.

C型肝硬変合併肝細胞癌に発生した腸腰筋膿瘍の1例

症例は73歳，男性．70歳時よりC型肝硬変，肝細胞癌に対しtranscatheter arterial chemoembolization（TACE），radiofrequency ablation（RFA）を中心とした加療を継続していた．熱発，および腰部から右大腿部に及ぶ疼痛を主訴に入院となり，CTにて右腸腰筋膿瘍と診断された．Child-Pugh分類Cという肝機能から全身麻酔を伴う手術加療は高リスクと判断し，局所麻酔下での後腹膜アプローチによる膿瘍ドレナージを選択した．膿瘍培養にて大腸菌を認め，術後の注腸所見では右半結腸憩室および盲腸瘻を認めたことから，盲腸憩室炎の後腹膜穿通による続発性腸腰筋膿瘍と最終的に診断した．肝硬変を伴う腸腰筋膿瘍の本邦報告例は9例と少なく，全身状態不良例に対しては，低侵襲な治療を選択することで，QOLを維持向上しえたと考えられた．

Microbiology and Outcome of Iliopsoas Abscess in 124 Patients

To describe the microbiology and outcome of iliopsoas abscess (IPA) in a large case series, we analyzed 124 cases of IPA collected from 1990 through 2004 in 11 hospitals in Spain. Twenty-seven (21.8%) patients had primary and 97 (78.2%) had secondary IPA. The main sources of infection were bone (50.5%), gastrointestinal tract (24.7%), and urinary tract (17.5%). A definitive microbial diagnosis was achieved in 93 (75%) cases. Abscess culture was the most frequent procedure leading to microbial diagnosis, followed by blood cultures. Staphylococcus aureus, Escherichia coli, and Bacteroides species were the most frequent microbial causes: S. aureus was the most common organism in patients with primary abscesses (42.9%) and with abscesses of skeletal origin (35.2%), whereas E. coli was the leading organism in those with abscesses of urinary (61.5%) and gastrointestinal (42.1%) tracts. Mycobacterium tuberculosis was found in 15 patients, 4 of them associated with human immunodeficiency virus (HIV) infection. Twenty (21.5%) cases had polymicrobial infections; these were more common among patients with abscesses of gastrointestinal origin. Information on clinical outcome was available for 120 patients; 19 (15.8%) had a relapse and 6 (5%) died due to complications related to the IPA. Patients who died were older and more likely to have bacteremia and E. coli isolated from cultures. In conclusion, secondary IPA is more prevalent than primary IPA. Among those with secondary IPA, most abscesses are secondary to a skeletal source. A bacterial etiology can be identified in most cases. The overall prognosis of patients with this condition is good.

Nine cases of iliopsoas abscess in our experience

Nine cases of iliopsoas abscess in our experience

Primary Iliopsoas Abscess: Report of a Case

Iliopsoas abscess is an uncommonly encountered clinical entity. Although diseases of the digestive tract or urinary tract or trauma can secondarily cause an iliopsoas abscess, the number of ”idiopathic” or ”primary” cases of iliopsoas abscess has been increasing since the later twentieth century. Unlike the intraperitoneal tissues, those of the extraperitoneum may demonstrate little visible reaction to bacterial contamination. Thus prolonged illness and high mortality rate due to delay in diagnosis or inadequate treatments are common. We present a case of iliopsoas abscess with a history of Child's class C liver cirrhosis. After fever and abdominal distention with progressive abdominal pain over left lower quadrant were noted, CT scan revealed a multiloculated abscess over the left retroperitoneum. After aggressive treatment with antibiotic therapy, surgical drainage and intensive care, the patient recovered and was discharged.

Iliopsoas abscess in the neonate

Iliopsoas abscess (IPA) is rare, especially in the neonatal period. The major presenting symptoms of IPA are leg or groin swelling, limitation of leg motion, and pain. The etiologies of IPA in many cases remain unknown, and the etiologic agent in many cases is Staphylococcus aureus. Ultrasonography and computed tomography are useful in diagnosing this disease. Antibiotics therapy and appropriate drainage are effective, and the prognosis is good. The authors present a neonatal case of IPA and discuss clinical symptoms, etiologic agents, methods of diagnosis and therapy, and prognosis.

腸腰筋膿ようの治療経験

We report six cases of iliopsoas abscess. Three patients had diabetes mellitus.All cases were treated conservatively with antibiotic therapy, and rest on the bed. Four out of six were carried out with echo-guided percutaneous drainage.We achieved successful results in all cases. Echo-guided percutaneous drainage could be the treatment of first choice for iliopsoas abscess.

Iliopsoas abscess: an unusual complication of femoral artery catheterization

We report a case of iliopsoas abscess following percutaneous transfemoral carotid angiography. To our knowledge there are no previous reports of this complication. The patient, a woman aged 49, was admitted for investigation of occlusive cerebrovascular disease. She was a smoker and had a history of exopthalmic Graves' disease and thyrotoxicosis, previously treated with Iodine 131. Current medications were thyroxine, Voltarol Retard and Nifedipine Retard. Prior to the procedure, haemoglobin level was 14.2 g/dl, white cell count was 8400 × 103/ml and platelet count was 283 000 × 103/ml. Full clotting studies were normal. Carotid arteriography was performed using a modified Seldinger technique. Full aseptic precautions were taken including groin shave, cleansing with chlorhexidine, povidone iodine skin preparation and sterile drapes and gowns. A 5 F Mani catheter (William Cook Europe ApS) and a 0.035 inch straight guidewire were used during the procedure which was protracted owing to inability to catheterize the left common carotid artery. A subsequent arteriogram using a 5 F pigtail catheter revealed complete occlusion of this vessel at its origin. Compression was applied to the puncture site for 20 min. The patient was well following the procedure and was discharged home shortly thereafter. Minor bruising only was seen at the puncture site. She presented again 22 days post-investigation complaining of increasing pain in the right groin and difficulty with walking. On examination she was pyrexial; and greenish, offensivesmelling fluid was oozing from the puncture site in the right groin.

Iliopsoas abscess: treatment by CT-guided percutaneous catheter drainage.

Eight cases of iliopsoas abscess were diagnosed and treated by computed tomographic (CT)-guided needle aspiration and percutaneous catheter drainage. The etiology varied but was definitely established in only four of eight cases. Seven of eight were successfully drained and surgery avoided. The eighth patient defervesced satisfactorily but ultimately required surgical debridement of a sacral osteomyelitis. Clinical, anatomic, and technical considerations for percutaneous drainage of iliopsoas abscesses are discussed. CT was essential both in early diagnosis and in guiding diagnostic needle aspiration and catheter placement. Image-guided percutaneous drainage appears to be the treatment of choice for iliopsoas abscess.