Sacroileítis infecciosa secundaria a un absceso del iliopsoas ­ reporte de un caso / Infectious sacroiliitis secondary to an iliopsoas abscess ­ a case report

La sacroileítis infecciosa (SII), también descrita en la literatura como sacroileítis séptica o piógena, es una patología infrecuente, y su diagnóstico constituye un reto debido a su rareza relativa y la diversa presentación clínica, que frecuentemente imita otros trastornos más prevalentes originados en estructuras vecinas. Se requiere un alto índice de sospecha y un examen físico acucioso para un diagnóstico oportuno, mientras que los estudios de laboratorio y de imagen ayudan a confirmar el diagnóstico y dirigir la estrategia de tratamiento apropiada para evitar complicaciones y secuelas a corto y mediano plazos. Presentamos un caso de paciente de género femenino de 36 años, con cuadro clínico de SII izquierda, secundaria a un absceso del músculo iliopsoas, condición que generalmente se presenta como una complicación de la infección. Se realizaron los diagnósticos clínico, imagenológico y Biológico, se inició el tratamiento antibiótico oportuno, y se logró una excelente evolución clínica, sin secuelas

Infectious sacroiliitis (ISI), also described in the literature as septic or pyogenic sacroiliitis, is an infrequent pathology, and its diagnosis constitutes a challenge due to its relative rarity and the diverse clinical presentation, frequently imitating other more prevalent disorders originating in neighboring structures. A high index of suspicion and a thorough physical examination are required in order to establish an opportune diagnosis, while laboratory and imaging studies help confirm the diagnosis and direct the appropriate treatment strategy to avoid complications and sequelae in the short and medium terms. We herein present a case of a female patient aged 36 years, with a clinical picture of left ISI, secondary to an iliopsoas muscle abscess, a condition that usually presents as a complication of the infection. The clinical, imaging and microbiological diagnoses were made, the timely antibiotic treatment was initiated, and an excellent clinical evolution without sequelae was achieved.

Fever with intradialytic pelvic pain: a case of iliopsoas abscess complicated with Methicillin-sensitive Staphylococcus Aureus bacteraemia in an end stage renal failure patient

Staphylococcus Aureus is a Gram-positive cocci bacteria which had been found to be the causative organism in over 88% of patients with primary iliopsoas abscess. We report the case of a 53-year-old diabetic woman with end-stage renal failure diagnosed with left iliopsoas abscess with a catheter-related infection. Computed tomogram (CT) of abdomen and pelvis revealed hypodense lesions of left psoas, iliacus and quadratus lumborum suggestive of psoas abscesses. In addition, osteomyelitis changes at left sacroiliac and hip joint were seen. At surgery, she was found to have abscess at the posterior psoas muscle where she underwent open surgery drainage and percutaneous drain was inserted. A high index of suspicion of iliopsoas abscess should be maintained among haemodialysis patients presenting with intradialytic pelvic and hip pain and treated with optimal antibiotics therapy with appropriate surgical intervention.

Iliopsoas Abscess Misconstrued as Aggravated Ankylosing Spondylitis / 대한내과학회지

An iliopsoas abscess is a collection of pus in the iliopsoas muscle caused by the direct spread of infection from adjacent internal organs or by hematogenous or lymphatic spread from distal sites. Its symptoms are vague back, hip, thigh or lower abdomen pain with insidious onset, similar to those of ankylosing spondylitis (AS). Therefore diagnosing an iliopsoas abscess in patients with AS is difficult. A forty-three year-old man was treated with adalimumab, a tumor necrosis factor inhibitor, and clinical symptoms were subsequently observed to improve. One year after voluntary discontinuation of adalimumab, the patient returned with a recurrence of right buttock pain and was diagnosed as having aggravated AS. Following re-initiation of adalimumab, symptoms did not improve and fever developed. On the basis of imaging studies, the patient was diagnosed as having an iliopsoas abscess and was successfully treated with intravenous antibiotics.

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

A 64-year-old female was admitted due to iliopsoas abscess caused by misplacement of a central venous catheter (CVC) into the ascending lumbar vein (ALV). Despite removing the CVC and administering an antimicrobial agent, her general condition did not improve. Therefore, we performed a contrast-enhanced head computed tomography (CT) scan. The CT scan revealed a cerebellum abscess. Surgical cerebellum abscess drainage was thus performed urgently. We recommend using anteroposterior radiographs, J-guide wire catheter and ultrasound guidance to prevent misplacement. If misplacement of the CVC is suspected, it should be removed and a CT scan performed without hesitation as soon as possible.

Septic Hip Arthritis with Iliopsoas Abscess Detected after Spine Operation: A Case Report / 대한고관절학회지

In the elderly patients who complain of pain in the buttock and leg, it is not easy to distinguish whether the pain comes from the lesion of the hip or from the spine. A 78-year-old female who was treated conservatively for persistent pain in the right buttock and leg after an operation for spinal stenosis in the local clinic visited our clinic. Septic hip arthritis with severe femoral head destruction and multiple abscesses in the buttock and iliopsoas muscle were diagnosed 2 months postoperatively, and spinal abscess in the site of the previous operation was detected by a subsequent MRI study. To avoid such a delay of the diagnosis and treatment, it is important to suspect hip joint lesion earlier for the source of persistent pain after a spine operation. Further more, diagnostic evaluation is necessary to rule out co-infection of the spine or iliopsoas muscle when a hip joint infection exists.

Iliopsoas Abscess Associated with Lumbar Spondylitis in a Chronic Spinal Cord Injured Patient: A case report

Iliopsoas abscess is relatively uncommon condition that can present with vague clinical features. Its insidious onset and occult characteristics can cause delayed diagnosis, resulting in high mortality and morbidity. We report a 49-year-old male with T7 complete paraplegia (ASIA A) as a result of motor vehicle accident in 1994, presented with fever above 40degrees C and myalgia for 15 days and later diagnosed as iliopsoas abscess. Magnetic resonance imaging showed infectious spondylitis, L3, with abscess formation in psoas muscle, bilateral. Intravenous broad spectrum antibiotics treatment, CT-guided percutaneous drainage and surgical management were performed. Febrile episodes are frequent in SCI (spinal cord injured) patients. However, it is sometimes difficult to ascertain the origin of fever in SCI patients, because of altered sensation and lack of localizing physical findings. We suggest that this infectious pathology must keep in mind in SCI patients with fever of unknown origin.

Acute Pyogenic Sacroiliitis Caused by Staphylococcus aureus without Predisposing Conditions / 감염과화학요법

Pyogenic sacroiliits is a rare disease and the diagnosis is difficult because of unawareness of the disease and nonspecific symptoms and signs mimicking septic hip, iliopsoas muscle abscess and herniation of intervertebral disk. There are some predisposing factors related to the disease like trauma, pregnancy, intravenous drug abuse and infection of other systems such as skin, genitourinary system and heart. Staphylococcus aureus is the most common causative bacteria. Here we describe a case of 27-year-old woman presented with acute onset of back and left buttock pain. Bone scintigraphy revealed increased uptake at left sacroiliac joint and computed tomography of the pelvis showed left sacroiliitis with left iliacus and iliopsoas abscess. There was no history of usual predisposing conditions. S. aureus was grown from blood cultures and the patient improved with 2 weeks of intravenous cefazolin followed by 4 weeks of oral clindamycin treatment.

Acute Pyogenic Sacroiliitis Caused by Staphylococcus aureus without Predisposing Conditions / 감염과화학요법

Pyogenic sacroiliits is a rare disease and the diagnosis is difficult because of unawareness of the disease and nonspecific symptoms and signs mimicking septic hip, iliopsoas muscle abscess and herniation of intervertebral disk. There are some predisposing factors related to the disease like trauma, pregnancy, intravenous drug abuse and infection of other systems such as skin, genitourinary system and heart. Staphylococcus aureus is the most common causative bacteria. Here we describe a case of 27-year-old woman presented with acute onset of back and left buttock pain. Bone scintigraphy revealed increased uptake at left sacroiliac joint and computed tomography of the pelvis showed left sacroiliitis with left iliacus and iliopsoas abscess. There was no history of usual predisposing conditions. S. aureus was grown from blood cultures and the patient improved with 2 weeks of intravenous cefazolin followed by 4 weeks of oral clindamycin treatment.

Iatrogenic Iliopsoas Abscess after Trigger Point Injection : A case report

After slip down, a 64 years old female had pain on the left buttock and the back without weakness or sensory change. Physical examination revealed tender points on left buttock and quadratus lumborum muscle. Straight leg raising test was 40degrees/20degrees. After trigger point injection on tender points, her symptoms were improved. Magnetic resonance imaging showed central extruded disc at L3-S1. After systemic steroid therapy was started, fever was developed about 39.3degrees C and laboratory evaluation showed inflammatory sign. Systemic steroid injection was stopped. Physical examination revealed a palpable and painful mass on the left lower quadrant of the abdomen. Ultrasonography and computerized tomography of abdomen and pelvis showed a large (7x5 cm) irregular shaped cystic mass along left iliopsoas muscle. Percutaneous catheter was inserted for drainage. Thick turbid yellow-greenish pus (300 cc) was drained. Intravenous antibiotics were administered and the patient's symptoms gradually improved. Culture of the pus revealed Streptococcus agalactiae.

A Case of Iliopsoas Abscess Complicated by Sacroiliitis / 대한류마티스학회지

Both pyogenic sacroiliitis and iliopsoas muscle abscess are relatively uncommon infectious entities, and their coexistence has been reported in few patients. Its insidious and obscure clinical manifestations can cause the diagnostic delays, resulting in high mortality and morbidity. But, the proper management with appropriate antibiotics and percutaneous drainage of the abscess has showed the satisfactory outcomes in most patients with iliopsoas abscess. In this report, we present a case of 45-year-old male with diabetes mellitus who had an iliopsoas abscess complicated by sacroiliitis.

Surgical Management of Primary Iliopsoas Abscess

PURPOSE: An Incidence of primary iliopsoas abscess is extremely rare. So it's clinical features are unclear. We reported the clinical features and treatment of primary iliopsoas abscess with reference review. METHODS: The ten cases of primary iliopsoas abscess from January 1999 to August 2003 were included in this study. We analyzed clinical manifestation, diagnostic modality, treatment and prognosis retrospectively. Microbiologic study and imaging study were performed in all patients. The treatments included surgical drainage, percutaneous drainage, and systemic antibiotics only were performed. RESULTS: In demographics of patient, the sex ratio was equal and mean age was 51.8 years old with predominant elderly (more than 60 years old). The abscess was confirmed by computed tomography in 8 patients, magnetic resonance imaging in 1. One abscess was found after laparotomy. The one side iliopsoas abscess was found in eight cases (right 4 cases and left 4) and bilateral abscess was in two cases. All cases were multilobulated abscess. After failure of percutaneous drainage, surgical drainage with retroperitoneal approach was performed in 8 patients. Transperitoneal drainage and systemic antibiotics therapy without drainage was respectively performed in one case. One case of abscess was recurred due to early removal of drain and insufficient antibiotics therapy. Other nine patients were completely resolved without complication or mortality. CONCLUSION: The diagnosis of primary iliopsoas abscess requires a high index of suspicion due to its rarity. If we consider that most iliopsoas abscess was multi-lobulated, early surgical drainage with sufficient administration of systemic antibiotics is an effective treatment modality.

A Case of Primary Iliopsoas Abscess Presented as Femoral Neuropathy in a Hemodialysis Patient / 대한신장학회잡지

Primary iliopsoas abscess is a rare but potentially serious condition. The diagnosis is frequently delayed due to its variable and nonspecific features and occult clinical course. The delayed diagnosis and treatment of iliopsoas abscess is the major poor prognostic factor. We report a rare case of primary iliopsoas abscess that presented as a femoral neuropathy in a patient on hemodialysis. A 49-year-old man with end stage renal disease was admitted due to pain in the left inguinal area, and weakness and hypoesthesia of left lower leg. Left iliopsoas abscess was confirmed by CT and MRI. Left femoral neuropathy was diagnosed with electrodiagnostic study. Iliopsoas abscess with femoral neuropathy was completely treated with CT-guided aspiration, antibiotics and prolonged physical therapy of hip and knee joints. To our knowledge, this is the first case report of primary iliopsoas abscess presented as a femoral neuropathy in a patient on hemodialysis in Korea.

Primary Iliopsoas Abscess due to Staphylococcus aureus: 3 cases reports

Primary iliopsoas abscess, without a causative infection focus, is a very rare kind of retroperitoneal abscess. Immunocompromised patient, such as elderly patients, diabetics and patients with chronic disease, are susceptible to this kind of infection. Because early diagnosis of priiliopsoas abscess is usually delayed due to nonspecific clinical presentation, proper treatment is also delayed which causes high mortality and morbidity. Recently we experienced three cases of primary iliopsoas abscess due to Staphylococcus aureus. Diagnosis of these cases was belatedly confirmed by using a abdominal-pelvic computerized tomography (CT) scan. Open surgical drainage via an extraperitoneal approach and administration of appropriate systemic antibiotics were required to save these patients. Based on a review of the literature, we evaluated the diagnosis and treatment of primary iliopsoas abscess.

Iliopsoas abscess detectedy ultrasonography and CT; a report of two cases.

Nowadays the cause of iliopsoas abscess has changed from tuberculous to non-tuberculous infection. The disease may be classified by primary source of infection. The source of primary iliopsoas abscess is uncertain. Secondary iliopsoas abscess occurs either by direct extension from the inflammatory process in the adjacent structures of from hematogenous spreading. Two cases of iliopsoas abscess were reported; one was primary and the other was secondary infection. The diagnosis depended upon ultrasonography, computed tomography and correlation with clinical context. The final results of the two patients were satisfactory.