Psoas Abscess Research Articles

1363. Most Psoas Abscesses are Pyogenic; not Tuberculous: Experience from South India

Abstract Background It is a common belief that psoas abscess in patients from developing countries like India are mostly tubercular in origin. However, most of the diagnosis of a tubercular psoas abscess are based on radiological features and are not confirmed microbiologically. It is possible that many cases of pyogenic psoas abscesses are misdiagnosed as tubercular due to lack of good quality microbiology lab facilities in developing nations. We studied the microbiology of psoas abscess in patients admitted to KIMSHealth, a tertiary care hospital in Kerala, South India. Methods Clinical details of patients with a diagnosis of psoas abscess over a 6-year period (2015 – 2020) were retrieved from electronic medical records. Microbiological investigations done included bacterial culture of the pus, fungal culture, mycobacterial culture, cartridge based nucleic acid amplification test for Mycobacterium tuberculosis and blood cultures. Results 21 patients who had complete clinical details were included. 15 of them were males and the median age was 58 years. Diabetes mellitus was the most common comorbidity (52%). Fever (61.9%) and back pain (52.4%) were the most common symptoms. The abscess was left sided in 11 patients, right sided in 7 and bilateral in 3. Vertebral involvement was present in 9 patients while hip joint was involved in 3 patients. A microbiological diagnosis was made in 14 patients (66%). Most commonly isolated organism was Staphylococcus aureus (8 patients,MSSA:6, MRSA:2) followed by E.coli (3)and Klebsiella pneumoniae (2). Blood cultures were positive in 5 patients. Anti-tuberculous therapy was started in only one patient, which was based on characteristic histopathology and negative bacterial cultures. Rest of the culture negative cases were also treated as pyogenic abscesses with antibiotics. Surgical drainage was done for 7 patients and pig tail drainage for 3 patients, while percutaneous aspiration was done for 9 patients. All 19 patients who followed up had clinical resolution, while two were lost to follow-up. Conclusion Contrary to what is believed, we observed that most psoas abscesses are pyogenic in origin. Our observations reiterates diligent microbiological investigations in all cases of psoas abscess to avoid empiric anti-tuberculous therapy. Disclosures All Authors: No reported disclosures

240. Epidural Involvement Complicating Pyogenic Spondylodiscitis

BackgroundPyogenic spondylodiscitis is an infection of the intervertebral disc(s) and/or adjacent vertebrae. It might be associated with epidural involvement. We aimed to study clinical, laboratory and evolutionary features of epidural involvement complicating pyogenic spondylodiscitis.MethodsWe conducted a retrospective study including patients hospitalized for spondylodiscitis with epidural involvement in the infectious diseases department between 2007 and 2019.ResultsWe included 22 patients among whom 16 were males (72.7%). The mean age was 64±11 years. Eleven patients had diabetes mellitus (50%). The onset of the disease was acute in 18 cases (81.8%) and sub-acute in 4 cases (18.2%). The median delay to diagnosis was 4 [2-13] weeks. The revealing symptoms were back pain (95.5%), fever (68.2%) and asthenia (54.5%). Motor deficit was noted in 9 cases (40.9%), sensory deficit in 4 cases (18.2%) and sphincter dysfunction in one case (4.5%). Physical examination revealed spinal tenderness (77.3%), paravertebral tenderness (22.7%) and spinal stiffness (18.2%). Blood cultures were positive in 13 cases (59.1%) represented by Staphylococcus aureus (31.8%). Elevated C-reactive protein levels (81.8%) and accelerated erythrocyte sedimentation rate (63.6%) were noted. Imaging features showed vertebral body osteolysis (81.8%), inflammation of adjacent soft tissue (81.8%), spinal cord compression (40.9%) and psoas abscess (13.6%). Along with medical treatment, immobilisation (72.7%), abscess drainage (13.6%) and surgery (9.1%) were indicated. The disease evolution was favourable in 20 cases (90.9%). Two patients were dead (9.1%). Sequelae were noted in 9 cases (40.9%) represented by back pain (31.8%) and spinal deformity (9.1%).ConclusionSpondylodiscitis complicated with epidural involvement might lead to complications and sequelae if not promptly diagnosed and treated. Disclosures All Authors: No reported disclosures

Factors Associated with Surgical Treatment Outcome of Psoas Muscle Abscess

Background: Psoas abscess is a rare condition but one with potential for severe morbidity. Many factors may be implicated in the treatment outcome of the condition and efforts must be directed to identify, understand and control the factors for a better prognosis.
 Objective: To identify the factors associated with surgical treatment outcome of psoas muscle abscess.
 Methodology: This descriptive cross-sectional study was conducted upon a sample of 58 patients (chosen via non-probability, consecutive sampling) scheduled for surgical treatment for psoas muscle abscess (aged 18 to 60 years) at department of General Surgery at Liaquat University Hospital, Hyderabad & Jamshoro. All the patients underwent surgical treatment. The data was recorded via pre-structured questionnaire comprising of inquiries pertaining to socio-demographic details, presenting complaints, and factors association with surgical treatment outcome (in terms of resolution of abscess cavity). Data was analyzed via SPSS version 20.
 Results: Mean age of study subjects was 37.6 ± 12.5 years. Out of all 72.4% were males and 27.5% were females. Most common presentation of patients was pain in flanks, followed by fever. The commonest etiological factor was tuberculosis (TB) and consequently spinal (TB) was the most common. Resolution of abscess cavity was noted among 77.5% of the cases with a greater proportion of recovery falling in line non- tuberculous etiology.
 Conclusions: After careful consideration, it can be concluded that secondary psoas muscle and that with tuberculous etiology have a poorer surgical outcome, thus greater care and more effective surgical techniques may be employed to achieve complete resolution of abscess.

Risk Factors of Coexisting Septic Spondylitis and Arthritis: A Case-Control Study in a Tertiary Referral Hospital.

Introduction: In patients under immunosuppression or severe sepsis, it is sometimes manifested as coexisting septic arthritis and spondylitis. The aim of this study is to evaluate and investigate the risk factors of infectious spondylitis associated with septic arthritis. Methods: The study retrospectively reviewed the patients diagnosed with infectious spondylitis between January 2010 and September 2018 for risk factors of coexisting major joint septic arthritis. Results: A total of 10 patients with infectious spondylitis and coexisting septic arthritis comprised the study group. Fifty matched patients with solely infectious spondylitis were selected as the control group. Major risk factors include preoperative C-reactive protein (p = 0.001), hypoalbuminemia (p = 0.011), history of total joint replacement (p < 0.001), duration of preoperative antibiotics treatment (p = 0.038) and psoas muscle abscess (p < 0.001). Conclusion: Infectious spondylitis and septic arthritis are thought of as medical emergencies due to their high mortality and morbidity. Our study evaluated 5 risk factors as significant major findings: hypoalbuminemia (<3.4 g/dL), higher preoperative CRP (>130 mg/L), psoas muscle abscess, longer preoperative antibiotics treatment (>8 days) and history of total joint replacement. Clinicians should pay attention to the patients with those five factors to detect the coexisting infections as early as possible.

STUDY OF MRI MORPHOLOGY OF SPINAL TUBERCULOSIS

OBJECTIVE: To study the morphology of tuberculosis of spine on MRI. METHODS AND MATERIALS: A retrospective study was done in the department of Radiodiagnosis, PESIMSR, Kuppam.This study includes 37 patients with suspected Spinal Tuberculosis, who were referred to the department of Radiodiagnosis between 2019 Jan to 2021 July. Informed consent was taken from all the patients. This study was done on GE Signa Explorer 1.5 Tesla. RESULTS: A total of 37 cases were included in the study. Of these 37 cases, 31 were males and 6 were females. The most common age group involved was between 20-40 years, seen in 15 cases followed by 41-60 yrs seen in 14 cases and 61-90 yrs seen in 8 cases. Lumbar vertebrae were commonly affected accounting for 86% of total cases (32cases) followed by dorsal and cervical vertebrae accounting for 8% and 5 % respectively (3 and 2 cases respectively). Intervertebral disc involvement (Discitis) was most commonly seen in 32 cases followed by vertebral endplate involvement (27 cases) in our study. Prevertebral &amp; paravertebral involvement were found in 20 and 23 cases respectively . In our study,19 cases had shown the involvement of posterior elements .Epidural soft tissue component was seen in 22 cases. Psoas abscess and paraspinal involvement were seen in 9 and 8 cases respectively. CONCLUSION: MRI helps in the early assessment of the extent and severity of disease compared to X-ray and CT scan. It is valuable in detecting early marrow changes, intervertebral disc involvement, extradural abscess and cord compression.

A case report of perinephric abscess extending as psoas abscess

Iliopsoas abscess is a rare clinical entity. It is even more uncommon for psoas abscess to develop in association with genitourinary infections like perinephric abscess because of the retroperitoneal anatomy. Here we present an unusual case of a perinephric abscess extending as psoas abscess which was treated with computed tomography (CT) guided drainage.

971 A Rare Case of a Reno-colic Fistula Presenting as a Retroperitoneal and Psoas Abscess

Abstract Background Fistulous connections arising between the kidney and colon are rare and develop due to multiple aetiologies. We present a rare case of a reno-colic fistula presenting unusually as a retroperitoneal and psoas abscess managed surgically with a good outcome. Case Report A 49-year-old lady presented with 5-day history of left flank pain and swelling with no significant surgical or medical history. Physical examination revealed a tender left renal angle with raised inflammatory markers (CRP and WCC). Computed tomography (CT) revealed an extensive collection extending from an atrophic left kidney through the retroperitoneum and psoas into the subcutaneous tissues with possible fistulation into the descending colon. This was initially treated with antibiotics and percutaneous drainage of the collection. A reno-colic fistula was confirmed via left retrograde pyelogram. Under the multidisciplinary care of the urology and colorectal general surgical teams she underwent a left nephrectomy, large bowel resection and defunctioning colostomy successfully and was discharged eight days later. Histology later confirmed an extensively scarred atrophic left kidney with multiple renal stones with no preserved glomeruli, focal inflammatory infiltrate and stromal calcification consistent with end stage nephropathy. With the resected 5 cm descending colon showing mucosal and serosal inflammation consistent with site of fistula. Conclusions Reno-colic fistula is rare and presentation with a retroperitoneal and psoas abscess uncommon. We report a rare case of a reno-colic fistula secondary to a chronically infected and obstructed left kidney managed surgically with a good outcome.

Psoas Abscess and Pott's Disease as a result of undiagnosed Latent Tuberculosis: A Case Report

Psoas Abscess and Pott's Disease as a result of undiagnosed Latent Tuberculosis: A Case Report

Report of Five Cases and Literature Review of Psoas Abscess

Report of Five Cases and Literature Review of Psoas Abscess

Fatal Case of a Contained Ruptured of the Infrarenal Aorta due to Simultaneous Primary Aortocaval Fistula and Aortoenteric Fistula

We report an extremely rare case of primary aortocaval fistula with simultaneous development of an aortoenteric fistula in a 68-year-old man. The patient developed under oral anticoagulation a spontaneous intracaval aortic rupture. An emergency intervention was performed with a covering of the fistula with an aorto-uniiliac stent graft and a femoro-femoral crossover bypass. One week later, the patient was transferred to our institution with the diagnosis of a psoas abscess and a suspected concomitant aortoenteric fistula. We performed a complete explantation of the endograft and implanted it after extensive debridement an aortobiiliac bypass, made of bovine pericardium. The postoperative course was complicated, first by bleeding from the left iliac anastomosis, and then by bleeding from the proximal aortic anastomosis. The entire graft was explanted and an axillo-femoral bypass was implanted. The patient then developed a multi-organ failure and died 3 months later. If possible, an extended surgical debridement and resection of all infected tissue with in situ reconstruction is the gold standard. However, with this therapy, there is still a high risk of reinfection. Long-term antibiotic management is mandatory.

A challenging diagnosis of pyrexia of unknown origin: isolated iliac tuberculous lymphadenitis complicated by psoas abscess

Pyrexia of unknown origin is a challenge in clinical practice. Extrapulmonary tuberculosis is considered a common cause for pyrexia of unknown origin which has a wide spectrum of clinical manifestations, culminating in delayed diagnosis. However, due to its treatable nature and good prognosis, a high index of suspicion is needed to diagnose atypical presentations. This case report elaborates isolated involvement of iliac lymph node in tuberculosis which is a rare presentation of tuberculous lymphadenitis.

Safety and efficacy of BI 695501 versus adalimumab reference product in patients with advanced Crohn's disease (VOLTAIRE-CD): a multicentre, randomised, double-blind, phase 3 trial

BI 695501 is a biosimilar that has demonstrated similar efficacy, safety, and immunogenicity to adalimumab reference product in patients with rheumatoid arthritis and chronic plaque psoriasis. The VOLTAIRE-CD study aimed to compare the efficacy and safety of BI 695501 with adalimumab reference product in patients with Crohn's disease. This phase 3, randomised, double-blind study was done at 92 centres in 12 countries across Europe and the USA in patients aged 18-80 years with moderately to severely active Crohn's disease (Crohn's Disease Activity Index [CDAI] score 220-450). Patients were randomly assigned 1:1 using an interactive response technology system to the BI 695501 group or adalimumab reference product group, stratified by previous exposure to infliximab (yes vs no) and simple endoscopic score for Crohn's disease at screening (<16 vs ≥16). All investigators involved in trial assessments or procedures and all patients were masked to treatment allocation until week 24. Patients received BI 695501 (40 mg/0·8 mL formulation) or adalimumab reference product (either 40 mg/0·4 mL citrate-free or 40 mg/0·8 mL) 160 mg on day 1 and 80 mg on day 15, followed by 40 mg every 2 weeks, via subcutaneous injection. The primary endpoint was the proportion of patients with clinical response (CDAI decrease ≥70 points) at week 4, with an exploratory non-inferiority margin of 0·76 for the lower limit of the two-sided 90% CI of the risk ratio (RR). The primary analysis was done in a modified full analysis set of all patients who received at least one dose of study medication and had a baseline and at least one post-baseline CDAI assessment. Safety was assessed in all patients who received at least one dose of study medication. After week 4, responders were treated until week 46; those randomly assigned to adalimumab reference product switched to BI 695501 at week 24. This study is registered at ClinicalTrials.gov (NCT02871635) and EudraCT (2016-000612-14). Between Jan 4, 2017, and April 5, 2018, 147 patients were enrolled and randomly assigned to BI 695501 (n=72) or adalimumab reference product (n=75). At week 4, 61 (90%) of 68 patients in the BI 695501 group and 68 (94%) of 72 in the adalimumab reference product group had a clinical response (adjusted RR 0·945 [90% CI 0·870-1·028]). In the safety analysis set, 45 (63%) of 72 patients in the BI 695501 group and 42 (56%) of 75 in the adalimumab reference product group had an adverse event during weeks 0-24; 31 (43%) and 34 (45%) had adverse events during weeks 24-56. The most common drug-related treatment-emergent adverse events during weeks 0-24 were weight increase (three [4%] patients in the BI 695501 group) and injection-site erythema and upper respiratory tract infection (three [4%] patients for each event) in the adalimumab reference product group. The only drug-related TEAEs reported in two or more patients during weeks 24-56 were weight increase and increased γ-glutamyltransferase, which occured in two (3%) patients each in the BI 695501 group. No drug-related TEAEs were reported in two or more patients during weeks 24-56 in the adalimumab reference product followed by BI 699501 group. Serious adverse events occurred in six (8%) patients in the BI 695501 group and eight (11%) in the adalimumab reference group between weeks 0-24, and two (3%) and nine (12%) patients between weeks 24-56. Adverse events of special interest occurred in two (3%) patients in each treatment group during weeks 0-24 (acute sinusitis and pulmonary tuberculosis in the BI 695501 group and anal abscess and postoperative wound infection in the adalimumab reference product group) and two (3%) patients in each group during weeks 24-56 (psoas abscess and hypersensitivity in the BI 695501 group and pulmonary tuberculosis and erythematous rash in the adalimumab reference product followed by BI 699501 group). Safety and efficacy were similar in patients with Crohn's disease treated with BI 695501 or adalimumab reference product. Treatment benefits were maintained in patients receiving adalimumab reference product who switched to BI 695501. These results further support the existing licensure of BI 695501 as an alternative to adalimumab reference product for patients with Crohn's disease, as well as the other indications for which BI 695501 is approved. Boehringer Ingelheim.

Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm

Mycotic Abdominal Aortic Aneurysm (MAAA) is a rare entity that accounts for around 2% of aortic aneurysms. Tuberculous involvement of the aorta is either through hematogenous route or by the way of direct extension of disease from the adjacent structures. It may affect the intima or several layers of the vessel wall resulting in inflammation of the aorta, termed as aortitis, which weakens the aortic wall. The variable immune response to this aortitis can thicken the aorta or can perforate it leading to aneurysm formation. Tuberculosis affects both abdominal and thoracic aorta equally. Neither medical treatment nor surgical repair is curative, when used alone. The various surgical techniques which have been used by the investigators, had refined over period of time and importance of complete clearance of the infective foci is emphasized. Despite advanced imaging techniques, anti-tubercular drugs and adequate surgical options in the present times, the prompt diagnosis and successful repair of tuberculous MAAA are very few in number and there is also possible risk of reactivation of tuberculous process and recurrence. A presentation of a combination of Pott’s spine, psoas abscess and tubercular MAAA is a rare entity with very high mortality. We report the successful surgical and medical treatment of this precarious presentation.

Anaesthetic management of a patient with severe kyphoscoliosis with left psoas abscess

Patients with Severe Kyphoscoliosis present with unusual challenges for the Anaesthetist. Achieving an adequate subarachnoid block (SAB) can be a daunting process let alone maintaining the airway due to their restrictive lung disease. We present a case of anaesthetic management and difficult intubation in a patient with severe kyphoscoliosis with left sided Psoas Abscess with failed SAB, restrictive lung disease having restricted neck movements using awake fibre optic intubation.

A rare case of periprosthetic Trueperella bernardiae following a total hip arthroplasty and antimicrobial stewardship

Trueperella bernardiae is a rare, anaerobic Gram-positive bacillus. Very few published clinical reports1 of Trueperella infections, eludes its true incidence and pathogenicity. We share a case of a 70-year-old woman with recurrent peri-prosthetic joint infection (PJI) following a total hip arthroplasty. A month after hip replacement, she presented with PJI, which was treated with extensive debridement and oral Ciprofloxacin in community for ESBL Enterobacteriaceae from peri-prosthetic samples. Five months later, she represented with peri-prosthetic collection which grew Trueperella bernardiae, during stage 1 hip revision. This was treated in hospital with six-weeks intravenous (IV) benzyl penicillin. A month after the second stage revision, she presents with hip re-collection that grew ciprofloxacin resistant Escherichia coli. She was managed in community with a 6-week IV carbapenem. However, 12 months later she developed a psoas abscess and subsequently elected for cessation of active management, leading to her demise. This report emphasises on the emergence of antimicrobial resistance2 Enterobacteriaceae due to constant antibiotic pressure, possibly causing a prosthetic joint infection by a rare Trueperella bernardiae, which was treated effectively by a narrow spectrum penicillin. This case report calls the need for antimicrobial stewardship3 while elucidating the existence of rare pathogens. 1.Loïez C, Tavani F, Wallet F, et al. An unusual case of prosthetic joint infection due to Arcanobacterium bernardiae. J Med Microbiol 2009; 58: 842–3.2.Serwecińska L. Antimicrobials and antibiotic-resistant bacteria: a risk to the environment and to public health. Water 2020; 12: 3313.3.McKenzie D, Rawlins M, Del Mar C. Antimicrobial stewardship: what’s it all about? Aust Prescr 2013; 36: 116–20.

A Case of Tuberculous Spondylitis in Child with Undernourish

Tuberculous spondylitis accounts for around 2% of all cases of Tuberculosis (TB) and around 15% of extrapulmonary TB cases. It has been reported that a 17 years old boy with a complaint of a bump on the lumbar region and felt low back pain since two years before admission with a history of back trauma. There was a decrease of body weight. There was no paraesthesia nor paralysis. Defecation and micturition were normal. Basic immunization was incomplete. On physical examination found palpable lymph nodes 0,5x0,5x0,5 cm, multiple et regio colli. There was no BCG scar. Impression nutritional status was undernourished. There was fixed palpable mass at back size about 5x4x5 cm, hard, no fluctuations, no rebound tenderness. Lung examination was normal. Tuberculin test showed induration sized 20 mm. Gene Xpert result Micobacterium Tuberculosis (MTB) not detected. On chest X-ray examination found L1-2 corpus destruction. MRI Spine was suggestive of compressive fractures and suggestive of a bilateral psoas abscess. Decompression and lumbar stabilization surgery were performed. The histopathology examination results were consistent to spondylitis TB characteristics. The patient was discharged on 6th hospitalization and given anti-tuberculous drug.Keywords: bump, extrapulmonary, fracture, spondylitis, tuberculosis

Treatment Guideline for Patients with Native Culture-negative Pyogenic Vertebral Osteomyelitis.

With the development of evidence-based guidelines for the diagnosis and antibiotic treatment of patients with pyogenic vertebral osteomyelitis, various nonsurgical and surgical treatment strategies have achieved favorable results. However, sufficient administration of appropriate antibiotics is a prerequisite for treatment success, which cannot be guaranteed in patients with culture-negative pyogenic vertebral osteomyelitis. Unfortunately, previous studies on culture-negative pyogenic vertebral osteomyelitis were limited by small patient groups, short follow-up periods, varied treatment protocols, and inconsistently defined clinical endpoints. Among patients treated according to our center's treatment protocol for culture-negative pyogenic vertebral osteomyelitis, which included patients treated without surgery, with surgery but without spinal instrumentation, as well as patients treated with instrumented surgery, (1) what proportion of patients in each treatment group experienced recurrence (or persistence) of infection, complications of treatment, and death; and (2) what factors were independently associated with recurrent or persistent infection after treatment under this algorithm? This was a retrospective evaluation of a treatment protocol in use at one center from 2008 to 2020. During that time, we treated 183 patients for culture-negative pyogenic vertebral osteomyelitis. The diagnosis was based on clinical, laboratory, and radiological features excluding disease that presents similar features to pyogenic vertebral osteomyelitis. For those patients, our protocol included three possible approaches: nonsurgical treatment, including the use of empirical antibiotics (nonoperative group, n = 82); spinal decompression without instrumentation (noninstrumented group, n = 41); and spinal decompression with instrumentation (instrumented group, n = 60). The indications for each treatment during the period remained relatively consistent. Nonsurgical treatment including empirical antibiotics was applied to all patients according to the specified antibiotic protocol. Spinal decompression without instrumentation was employed when a patient presented substantial or aggravating neurologic deficits or intractable pain from an abscess. Instrumentation was added in patients with mechanical instability before or after spinal decompression. Minimum follow-up to be included in this study was 1 year, and 91% (252 of 277) of patients were accounted for at that time, with no differential loss to follow-up among the study groups (12, five, and four patients missing from the three groups, respectively, at 1 year). Chart review was performed to ascertain the proportion of patients in each group who experienced recurrence, complications, and death. Factors associated with recurrence were assessed across the entire cohort using a multivariable logistic model. We analyzed 1-year recurrence and mortality rates using the Kaplan-Meier method, and their 95% confidence intervals were calculated using the method by Hosmer and Lemeshow. At 1 year, the recurrence-free survival rate was 87% (95% confidence interval 78% to 93%) in the nonoperative group, 87% (95% CI 72% to 94%) in the noninstrumented group, and 91% (95% CI 80% to 96%) in the instrumented group. The proportion of patients who experienced a major medical complication in each group was 12% (10 of 82), 10% (4 of 41), and 8% (5 of 60), respectively. At 1 year, the survival rate with patient death as the endpoint was 95% (95% CI 88% to 98%) in the nonoperative group, 95% (95% CI 82% to 99%) in the noninstrumented group, and 97% (95% CI 87% to 99%) in the instrumented group. After controlling for potentially confounding variables including age, medical comorbidities, and anatomical involvement of infection, the following factors were independently associated with increased odds of infection recurrence or persistence: higher Charlson Comorbidity Index (CCI) score (odds ratio 1.6 per point on the CCI [95% CI 1.2 to 2.1]; p = 0.004) and the presence of a psoas abscess (OR 4.7 [95% CI 1.6 to 13.9]; p = 0.005). Among patients with negative initial nonoperative culture results, spinal decompression and abscess drainage can be used in those with substantial or aggravating neurological deficits or intractable pain caused by an abscess, while additional early spinal instrumentation can be applied upon consideration of their medical comorbidities and the presence of a psoas abscess when mechanical instability is present before or after the spinal decompression. Reasonable clinical results can be expected, regardless of the results from subsequent operative cultures. However, our study results should be replicated by other centers, and further studies that consider individual differences such as bone mineral density and include patients with previous spinal instrumentation or recurrent infection should be performed to establish a more comprehensive treatment protocol. Level IV, therapeutic study.

MO219EMPHYSEMATOUS PYELONEPHRITIS IN BANGLADESH

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is an uncommon, acute and severe form of necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues and is characterized by accumulation of gas within these structures. Patients may present with fever, loin pain, vomiting and shock. Risk factors for EPN include diabetes mellitus (DM), renal stone, obstructive uropathy and immunosuppression. In this report, we describe the clinical, laboratory and imaging characteristics of patients with EPN in Bangladesh. Method This systematic review included all previously published English literature containing information regarding EPN in/or from Bangladesh. Literature search was conducted via “PubMed” using the key words “Bangladesh” and “emphysematous pyelonephritis”. We also searched through Bangladesh Journals Online (BanglaJOL) for articles published in local journals. The search engine “Google” was also used to identify articles. All literature searches were conducted up to 10th January 2021. Unpublished but well-documented EPN cases (28 cases) were added. Cases mentioned elsewhere with inadequate information and possible repetition were excluded. Results Seventeen papers were identified from published literature including 10 case reports, two original research articles, one image and four conference abstracts and one research paper was identified from other source. From them, two case reports were excluded because EPN occurred in non-Bangladeshi nationals; one image and four conference abstracts were also excluded because of inadequate information for cases. Finally, a total of 10 papers (total 92 cases) were eligible for analysis, to which 28 unpublished but well documented cases were added. Among the total 120 cases, females were 92 (76.7%). Age of the patients ranged between 20 and 77 years. DM was the commonest risk factor (118, 98.3%); 16 (13.3%) patients had chronic kidney disease and nine (7.5%) had renal stones. Patients presented with fever (112, 93.3%), loin pain/renal angle tenderness (96, 80%), dysuria (76, 63.3%), altered sensorium (21, 17.5%), anorexia (93, 77.5%), vomiting (101, 84.2%), dehydration (77, 64.2%) and shock (18, 15%). Patients had neutrophil leukocytosis (total white cell counts 11,700–54,200/cmm of blood) and 22 (18.3%) patients had thrombocytopaenia. All patients had high erythrocyte sedimentation rate (36–117 mm/1st h) and C-reactive protein (24–199 mg/L). Overall glycaemic status was poor [random blood glucose during admission was 6.8–35.5 mmol/L and glycated haemoglobin (HbA1c) was 6.2–16.1%]. Fifty six (46.7%) patients were complicated by acute kidney injury (AKI) and 32 (26.7%) patients had hyponatraemia. Diagnosis of EPN was confirmed by computed tomography scan. One patient had EPN in ectopic right kidney, two patients had EPN along with emphysematous cystitis and two patients were complicated with psoas abscess. According to Huang and Tseng classification, five (4.2%) patients had class 4 EPN, 35 (29.2%) patients had class 3, 66 (55%) patients had class 2 and 14 (11.7%) patients had class 1 EPN. Escherichia coli was the most common (67, 55.8%) organism identified on urine culture and 17 (14.2%) patients were complicated by bacteraemia. All patients were treated with resuscitative measures, intravenous antibiotics and other supportive measures. Forty one (34.2%) patients required surgery/interventions [nephrectomy in 19 (15.8%), percutaneous drainage in two (1.7%), open drainage in 20 (16.7%)]. Duration of hospital stay was 6–37 days. Nine (7.5%) patients died in hospital. Conclusion EPN occurred predominantly among female diabetic patients. Clinical presentation included fever, loin pain, dysuria, vomiting, altered sensorium and shock. Class 2 EPN was common. Almost half of all EPN cases developed AKI. One-third EPN cases required surgical interventions including nephrectomy. In-hospital mortality was 7.5%.

Psoas abscess in an adolescent with diabetes mellitus

Psoas abscess is rare condition which occurs from a spread of nearby or distant infection. Although diabetes mellitus is the most important risk factor for psoas abscess, there are few cases reported psoas abscess in patients with diabetes mellitus. We reported a rare entity case of psoas abscess in a16 year's old adolescent patient who had poorly controlled diabetes mellitus type 1. He presented with diabetic ketoacidosis, right flank, and low back pain. Computed tomography showed an accumulation of fluid in right psoas muscle. After resuscitation with fluid and giving intravenous antibiotics, our patient underwent successful percutaneous drainage of the pus. Fluid culture revealed staphylococcus aureus. After 15 days, we discharged him with course of ciprofloxacin. Follow-up for five months showed no recurrence. To best of our knowledge, this is the fifth case of psoas abscess in an adolescent patient who had diabetes mellitus.

Outcome of Percutaneous Ultrasound Guided Aspiration versus Open Surgical Drainage of Psoas Muscle Abscess

Objective: To compare the outcome of percutaneous ultrasound guided aspiration V/S open surgical drainage for psoas muscle abscess.&#x0D; Methodology: This comparative study was conducted in department of general surgery at Liaquat medical university hospital Hyderabad/Jamshoro, from June 2017 to November 2017. Diagnosed Patients of psoas muscle abscess size more than 5cm, between 18 to 60 years of age and either of gender were included. Patients were randomly divided into two groups, A and B by odd and even method, patients in group A abscess was aspirated by percutaneous ultrasound guided aspiration and patients in group B was underwent open surgical drainage, all the data were entered in the pre designed performa and analyzed into SPSS V:16.0&#x0D; Results: A total of 58 patients of Psoas muscle abscess were selected, the mean age of study subjects of group A was 38.5+10.5 and group B was 36.5+12.7 (p-673). Early post-operative pain relief was assessed among patients of group A as compared to group B. As per outcome resolution of abscess cavity was significantly high among patients of group B (p-0.004), while post-operative Hospital stay was significantly lower in group A (p-0.002).&#x0D; Conclusion: Both techniques has their own benefits like percutaneous aspiration has shorter duration of hospital stay while in complete resolution of abscess cavity was found in open surgical drainage group of patients.