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A case report of an atypical presentation of pyogenic iliopsoas abscess

BACKGROUND: Iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment. It can be primary or secondary in origin. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site. This is commonly associated with a chronic immunocompromised stat...

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Autores principales: Xu, Bang Yu, Vasanwala, Farhad Fakhrudin, Low, Sher Guan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335813/
https://www.ncbi.nlm.nih.gov/pubmed/30654745
http://dx.doi.org/10.1186/s12879-019-3675-2
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author Xu, Bang Yu
Vasanwala, Farhad Fakhrudin
Low, Sher Guan
author_facet Xu, Bang Yu
Vasanwala, Farhad Fakhrudin
Low, Sher Guan
author_sort Xu, Bang Yu
collection PubMed
description BACKGROUND: Iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment. It can be primary or secondary in origin. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site. This is commonly associated with a chronic immunocompromised state and tends to occur in children and young adults. Secondary iliopsoas abscess occurs as a result of the direct spread of infection to the psoas muscle from an adjacent structure, and this may be associated with trauma and instrumentation in the inguinal region, lumbar spine, or hip region. The incidence of iliopsoas abscess is rare and often the diagnosis is delayed because of non-specific presenting symptoms. CASE PRESENTATION: We describe a patient with iliopsoas abscess who presented to the Emergency Department at X Hospital on three separate occasions with non-specific symptoms of thigh pain and fever before finally being admitted for treatment. This case illustrates how the diagnosis can be delayed due to its atypical presentation. Hence, highlighting the need for clinicians to have a high index of clinical suspicion for iliopsoas abscess in patients presenting with thigh pain and fever. CONCLUSION: The classic triad of fever, flank pain, and hip movement limitation is presented in only 30% of patients with iliopsoas abscess. Clinicians should consider iliopsoas abscess as a differential diagnosis in patients presenting with fever and thigh pain. The rare condition with the varied clinical presentation means that cross-sectional imaging should be considered early to reduce the risk of fulminant sepsis.
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spelling pubmed-63358132019-01-23 A case report of an atypical presentation of pyogenic iliopsoas abscess Xu, Bang Yu Vasanwala, Farhad Fakhrudin Low, Sher Guan BMC Infect Dis Case Report BACKGROUND: Iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment. It can be primary or secondary in origin. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site. This is commonly associated with a chronic immunocompromised state and tends to occur in children and young adults. Secondary iliopsoas abscess occurs as a result of the direct spread of infection to the psoas muscle from an adjacent structure, and this may be associated with trauma and instrumentation in the inguinal region, lumbar spine, or hip region. The incidence of iliopsoas abscess is rare and often the diagnosis is delayed because of non-specific presenting symptoms. CASE PRESENTATION: We describe a patient with iliopsoas abscess who presented to the Emergency Department at X Hospital on three separate occasions with non-specific symptoms of thigh pain and fever before finally being admitted for treatment. This case illustrates how the diagnosis can be delayed due to its atypical presentation. Hence, highlighting the need for clinicians to have a high index of clinical suspicion for iliopsoas abscess in patients presenting with thigh pain and fever. CONCLUSION: The classic triad of fever, flank pain, and hip movement limitation is presented in only 30% of patients with iliopsoas abscess. Clinicians should consider iliopsoas abscess as a differential diagnosis in patients presenting with fever and thigh pain. The rare condition with the varied clinical presentation means that cross-sectional imaging should be considered early to reduce the risk of fulminant sepsis. BioMed Central 2019-01-17 /pmc/articles/PMC6335813/ /pubmed/30654745 http://dx.doi.org/10.1186/s12879-019-3675-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Xu, Bang Yu
Vasanwala, Farhad Fakhrudin
Low, Sher Guan
A case report of an atypical presentation of pyogenic iliopsoas abscess
title A case report of an atypical presentation of pyogenic iliopsoas abscess
title_full A case report of an atypical presentation of pyogenic iliopsoas abscess
title_fullStr A case report of an atypical presentation of pyogenic iliopsoas abscess
title_full_unstemmed A case report of an atypical presentation of pyogenic iliopsoas abscess
title_short A case report of an atypical presentation of pyogenic iliopsoas abscess
title_sort case report of an atypical presentation of pyogenic iliopsoas abscess
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335813/
https://www.ncbi.nlm.nih.gov/pubmed/30654745
http://dx.doi.org/10.1186/s12879-019-3675-2
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