RESUMO
Iliopsoas hematomas (IPH) are defined as a spontaneous or traumatic retroperitoneal collection of blood involving the iliopsoas muscle. In some cases, intramuscular hematomas can progress to abscesses and put the patient at risk for further complications. Our objectives are: to describe the etiology of intramuscular hematoma and psoas abscess, to describe the clinical signs and treatment of intramuscular hematoma and psoas abscess, and to analyze the association between uncontrolled diabetes mellitus and psoas abscess progression, which we achieve through retrospective case analysis and associated literature review on symptom constellation. We present the case of a 40-year-old male patient with a history of diabetes mellitus and alcohol abuse who presented with three days of increasing back and left lower extremity pain, confusion, auditory hallucinations, and fever found to be in diabetic ketoacidosis. Six days prior, the patient presented to the Emergency Department (ED) after being struck by a motor vehicle while ambulating found to have bruising, weakness in his lower extremities, and an L2 vertebrae fracture found on CT. During the presentation, the patient was found to have decreased muscle strength, leukocytosis with elevated lactate, and CT findings suggestive of a left psoas abscess drained by interventional radiology. Vancomycin and Cefepime were used as an empiric antibiotic regimen. The culture of the wound was then found to grow Methicillin-susceptible Staphylococcus aureus (MSSA) bacteria and antibiotics were then adjusted to Vancomycin and Cefazolin. During the patient's hospital stay, he developed two more abscesses on his bilateral psoas muscles, which were promptly percutaneously drained by interventional radiology. This case describes an uncommon progression of an Iliopsoas hematoma to a psoas abscess, likely due to his immunocompromised status secondary to his uncontrolled diabetes mellitus. Uncontrolled diabetes mellitus has been shown in various studies to be an independent risk factor of intramuscular hematoma progress to psoas abscess. We suggest that patients displaying fever, chills, flank pain, limited hip movement, and indications of uncontrolled diabetes should be approached with a high degree of suspicion for a psoas abscess.
RESUMO
Inflammatory bowel disease (IBD) consists of two primary conditions: ulcerative colitis (UC) and Crohn's disease (CD). UC primarily impacts the colon, leading to inflammation of the mucosal layer. Conversely, CD involves transmural inflammation and can affect any segment of the gastrointestinal tract, ranging from the oral cavity to the perianal region. Patients with CD can have symptoms for many years prior to diagnosis, or they may present acutely. We present the case of a 31-year-old male with a recent CD diagnosis and otherwise, no past medical history presenting with a week-long history of bilateral lower extremity swelling that started in the thighs and progressed downward, accompanied by a heavy sensation in the legs and intermittent numbness. Less than 24 hours into his hospital course, the patient experienced progressive bilateral numbness, saddle anesthesia, and urinary incontinence. Subsequently, the patient was taken for STAT MRI and emergent neurosurgery to alleviate the spinal cord compression and remove/biopsy a mass at the T6-T7 level that was later defined as a B-cell lymphoma. Our objectives are to describe the etiology of IBD complicated by lymphoma, to analyze the association between IBD and lymphoma, and to investigate the role that immunosuppressants play in the development of lymphoma from IBD, which we achieve through retrospective case analysis and associated literature review on symptom constellation. There is good evidence that malignant lymphoma of the bowel is a rare but significant complication of IBD in immunosuppressant-naive patients, apparently being more common in chronic UC. We suggest increased surveillance for this disease in immunosuppressant-naive patients, as the prognosis of lymphoma depends on the time of diagnosis.