Polybacterial Iliopsoas Muscle Abscess as an Indication for Early Diagnosis of Crohn's Disease.

BACKGROUND Crohn disease (CD) is a chronic, relapsing inflammatory bowel disease characterized by penetrations or fistulae in the gastrointestinal tract and abscesses in the surrounding tissues. Diagnosis of CD is difficult with an iliopsoas muscle abscess (IMA) as an initial presentation. CASE REPORT A 22-year-old Japanese man had right hip pain 17 days prior to admission. Because of worsening pain, he was admitted to our hospital. Physical examination revealed limitation of his right hip motion and a positive right psoas sign. Abdominal contrast-enhanced computed tomography (CT) revealed a large right IMA. Continuous drainage, which revealed polymicrobial pus, with intravenous administration of antibiotics dramatically decreased the size of the IMA. The drainage tube was removed on hospitalization day 9 because barium enema and contrast radiography of the abscess through the drainage tube showed no fistula. However, on day 19 of hospitalization, the IMA was redetected by abdominal CT. Continuous abscess drainage was resumed, and the third contrast radiograph of the abscess revealed contrast medium flow into the small intestine. Colonoscopy detected stenoses and circumferential ulceration of the terminal ileum. Histopathological examination of the ileum biopsy showed histocyte aggregation with lymphocyte or plasmacyte infiltration of the lamina propria, compatible with a CD diagnosis. Laparoscopic ileocecal resection was performed on day 64 of hospitalization. CONCLUSIONS Penetration of the intestinal tract caused by CD should be suspected in a patient with a polymicrobial IMA. It is essential to identify the fistula and subsequently perform surgical resection of the affected intestinal area.

An 81-year-old male with iliopsoas abscess by Streptococcus sanguis.

Iliopsoas muscle abscess is an uncommon condition, which has been growing in incidence. We describe a primary iliopsoas abscess by Streptococcus sanguis affecting an 81-year-old man cured by antibiotic therapy and aspiration procedure. The objective is to enhance the suspicion index about the iliopsoas abscess that may be mistaken for other causes of acute abdomen. The important diagnostic role of abdominal imaging studies is also emphasised.

Polyarticular septic arthritis with bilateral psoas abscesses following acupuncture.

We report a case of polyarticular septic arthritis with bilateral psoas abscesses. A 50-year-old woman was admitted with fever, multiple joint swelling and pain. She had a clinical history of acupuncture therapy for treatment of her chronic lower back pain two days before the appearance of her symptoms. Methicillin-sensitive Staphylococcus aureus was isolated from blood culture, knee joint fluids and psoas abscess. After a long course of antibiotics for 70 days together with drainage of the abscess, the condition completely resolved. The acupuncture is the probable cause of the infection, and this case report reveals the importance of asking about a clinical history of acupuncture treatment and of making repeated bacterial examinations in undiagnosed polyarthritis patients.

Paraplegia caused by spinal infection after acupuncture.

STUDY DESIGN: Case report of a 64-year-old man with psoas abscesses, epidural abscess and spondylitis after acupuncture. OBJECTIVE: To report a case of paraplegia caused by spinal infection after acupuncture. SETTING: Seoul, Korea. CASE REPORT: A 64-year-old man came to an emergency room because of severe back pain. At 3 days prior to visit, the patient received acupuncture therapy to the low back with a needle about 10 cm in length because of back pain. Pain was aggravated gradually for 3 days. Escherichia coli sepsis developed with altered mentality during admission. At hospital day 9, he regained his consciousness and was found to have paraplegia. Abdominal computerized tomography (CT) and lumbar spine magnetic resonance imaging (MRI) revealed abscesses of bilateral psoas muscles and spondylitis with epidural abscess. After conservative management with intravenous administration of antibiotics, infection was controlled but the patient remained paraplegic (ASIA scale C L1 level) without neurological recovery. CONCLUSION: Paraplegia might result from complications of an acupuncture therapy.

Recurrent infections caused by cefotaxime- and ciprofloxacin-resistant Salmonella enterica serotype choleraesuis treated successfully with imipenem.

We present a case of recurrent infection (infective spondilitis, psoas abscess, and bacteraemia) caused by a single strain of cefotaxime- and ciprofloxacin-resistant and bla(CMY-2)-containing Salmonella enterica serotype choleraesuis during a 4-month period in a patient with uremia. The patient was successfully treated with imipenem for 7 weeks. Our observation indicates that a carbapenem might be considered as a drug of choice for the treatment of infections caused by this emerging multi-resistant pathogen.

Propionibacterium avidum sacroiliitis and osteomyelitis.

The anaerobic Gram-positive bacterium Propionibacterium avidum is a common inhabitant of the skin with low pathogenicity. We report a case of P. avidum sacroilitis, psoas abscess and osteomyelitis in a 67-year-old male who had recently undergone surgical repair of an inguinal hernia. The organism was recovered from blood cultures, a bone biopsy specimen and specimens from the abscess. The spectrum of bone and joint infections caused by Propionibacterium is discussed. Infection by Propionibacterium spp. should be considered in patients with bone and joint infections.