Eggerthella lenta bacteremia complicated by spondylodiscitis, psoas abscess, and meningitis.

Eggerthella lenta bacteremia is uncommon and generally associated with abdominal sepsis. The organism and its clinical significance have not been well characterized due to historical difficulties with identification. We report a case of severe infection in a paraplegic man complicated by psoas abscess, osteomyelitis, and meningitis and discuss treatment challenges.

Iliopsoas abscess: an unexpected sequela of dilation and evacuation.

OBJECTIVE: This study aimed to report the case of a patient who developed an iliopsoas abscess after a dilation and evacuation for a midtrimester fetal demise. MATERIALS AND METHODS: This is a case report of a 35-year-old woman who underwent a dilation and evacuation at 17 weeks' gestation because of a preterm premature rupture of membranes and fetal demise. Four days later, she presented with fevers, chills, malaise, and right lower back, hip, and thigh pain. Magnetic resonance imaging of the abdomen and pelvis revealed a 2.3 × 1.6-cm right iliopsoas abscess. RESULTS: The patient underwent computed tomography-guided drainage of the abscess and made an uneventful recovery after completion of an antibiotic course and physical therapy. CONCLUSIONS: An iliopsoas abscess should be considered in the differential diagnosis of any woman presenting with fevers, chills, and unilateral lower back, hip, and thigh pain in a radicular pattern after a recent dilation and evacuation.

Retrospective review of clinical presentations, microbiology, and outcomes of patients with psoas abscess.

OBJECTIVE: The clinical features of patients with psoas abscess in a local setting, including the microbiology, incidence and aetiologies, have not been well described. This study aimed to review such clinical features and patient outcomes. DESIGN: Retrospective case series. SETTING: Regional hospital, Hong Kong. PATIENTS: Adults (aged ≥18 years) with psoas abscess admitted to Tuen Mun Hospital from 1 January 2006 to 31 December 2010 were included. The clinical presentations, aetiologies, microbiology, treatments, hospital stays, intensive care unit admissions, and outcomes of these patients were reviewed. RESULTS: The series entailed 42 patients, five of whom developed their psoas abscess after admission and seven were intravenous drug abusers. The most common presenting symptom in community-onset cases was back, hip, or thigh pain (43% [16/37]). Fever was present at presentation in 41% (15/37) of these patients, four of whom presented with fever only. The diagnosis was made by computed tomography in 95% (40/42) of these cases. In all, 23 abscesses were considered secondary; the most common aetiology being infective spondylitis or spondylodiscitis. The commonest causative organism for a primary psoas abscess was methicillin-sensitive Staphylococcus aureus, while for secondary abscesses they were more commonly from the gastro-intestinal and genitourinary tracts. Overall in-hospital mortality rate was 14% (6/42). Secondary psoas abscess patients had longer hospital stays (mean, 62 vs 34 days; P=0.007). CONCLUSION: Psoas abscess is an uncommon condition. Most patients presented with only non-specific symptoms leading to difficulty in making an early diagnosis. In more than half of these patients, the psoas abscesses were secondary, the aetiology of which differed from reported overseas experience.

Hip pain and cauda equina syndrome.

Acute cauda equina syndrome secondary to a spinal epidural abscess as a result of a psoas abscess is very uncommon. We report the case of a 64-year old with a 6-day history of left hip pain, which progressively worsened until she presented to the emergency department with systemic infective symptoms and classical acute cauda equina syndrome. A good clinical outcome was achieved by urgent posterior decompression, followed by CT-guided drainage of the psoas abscess and appropriate antibiotic treatment.

Retroperitoneoscopic drainage of complicated psoas abscesses in patients with tuberculous lumbar spondylitis.

PURPOSE: Nowadays, endoscopic techniques are widely used in surgical procedures. Retroperitoneoscopy has been an extremely valuable tool for a wide variety of urologic disorders, whereas, it has limited use in orthopedic procedures. METHODS: We performed retroperitoneoscopic drainage (in combination with medical treatment) of complicated psoas abscess on 12 patients with tuberculous spondylitis. All the procedures were done under general anesthesia and in the lateral decubitus position. Psoas abscess was evacuated during procedure, and postoperatively, drainage was continued through a large silastic tube. The definitive diagnosis and the treatment were made based on the results of culture-antibiogram and PCR testing. RESULTS: Complete clinical and radiologic remission was observed in all patients in 3-6 months. The complication was not observed in any case postoperatively. CONCLUSIONS: Retroperitoneoscopic drainage of psoas abscesses gains advantages in terms of rapid recovery, minimal invasiveness, absence of radiation, and shorter hospital stay. This procedure can be used not only for cold abscesses but also for other pathologies of lumbar vertebral area.

A rare diagnostic challenge in acute appendicitis: a case report.

Although rare, acute appendicitis presenting as a remote abscess with cellulitis in the gluteal region, retroperitoneal region, groin, or thigh does occur and may present a diagnostic challenge. We report a case of a 78-year-old woman presenting with an extensive gas-forming abscess in the right gluteal region secondary to perforated appendicitis without significant gastrointestinal symptoms. Computed tomography (CT) demonstrated a retroperitoneal abscess extending along the sacropelvic surface of the ilium to the subcutaneous tissue. Subsequently, laparotomy revealed retrocecal appendicitis perforated at the base of the cecum, and contained in the retroperitoneum without any signs of peritonitis. This case not only represents an unusual manifestation of acute appendicitis, but also alerts us to the importance of anatomical considerations when interpreting disease extent with imaging. In the differential diagnosis of gluteal or upper thigh abscesses, the rare possibility of perforated acute appendicitis should be considered.

Pyogenic psoas abscess on the dorsal side, and bacterial meningitis and spinal epidural abscess on the ventral side, both of which were induced by spontaneous discitis in a patient with diabetes mellitus: A case report.

Type 2 diabetes mellitus patients are immunocompromised, particularly under poorly controlled conditions, and thereby they could develop rare inflammatory diseases, such as spontaneous discitis, pyogenic psoas abscess, spinal epidural abscess and bacterial meningitis. Herein we report a pyogenic psoas abscess on the dorsal side, and bacterial meningitis and spinal epidural abscess on the ventral side, both of which were induced by spontaneous discitis in a patient with poorly controlled type 2 diabetes mellitus. This case was very rare and interesting, because we successfully treated various infections with antibiotics over a long period of time, complicated by hyperglycemic crises, although the patient suffered severe bone destruction and required rehabilitation for a long time.

Primary psoas abscess extending to thigh adductors: case report.

BACKGROUND: Psoas abscess is a rare condition consisting of pyomyositis of the psoas. The worldwide incidence was 12 cases per 100,000 per year in 1992, but the current incidence is unknown. Psoas abscess can descend along the psoas sheath and reach the inner upper third of the thigh, but only infrequently does it penetrate the sheath and involve the thigh adductors. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge. Delayed diagnosis can result in poor prognosis. CASE PRESENTATION: A 45-year-old male with no significant past medical history presented with pain in the left thigh, and limitation of movement at the left hip and knee joint for one month. Ultrasound, CT, and MRI revealed a liquid mass in the left psoas. Percutaneous drainage of this mass yielded 300 ml pus from the psoas. After surgery, the patient reported relief of pain; however, ten days after removal of the drainage tube, the patient complained of persistent pain in his left thigh. CT revealed that the psoas abscess had extended inferiorly, and involved the entire set of adductors of the left thigh. Open surgical drainage was performed at the flank and at the thigh, yielding 350 ml of pus from the thigh. After open drainage and adequate antibiotic therapy, the patient made a good recovery. Follow-up CT confirmed complete resolution of the abscess. CONCLUSIONS: Large psoas abscess can penetrate the psoas sheath, and descend to thigh adductors even after percutaneous drainage. Appropriate treatment includes open surgical drainage along with antibiotic therapy.

Tropical primary pyomyositis in children of the UK: an emerging medical challenge.

Pyomyositis is a commonly encountered condition in the tropics. It was not described in the UK until 1998. The reason for the increasing incidence is not understood. We sought to identify the experience gained of this condition within a UK paediatric tertiary referral unit. Retrospective review of cases of pyomyositis from our institution since 1998 was undertaken to identify demographics, presentation, diagnosis and management. Thirteen cases were identified. The obturator internus was most commonly affected (62%). Staphylococcus aureus was cultured in nine cases (69%). One diagnostic retroperitoneal exploration was performed and all cases were identified by computed tomography or magnetic resonance imaging. To our knowledge, this is the first UK series of pyomyositis, reflecting its increasing Western incidence. Early diagnosis and treatment with antibiotics is all that is needed in the majority of cases. A greater awareness of this emerging condition is necessary to prevent misdiagnosis and unnecessary surgical intervention by all surgeons.

Tuberculosis in medieval Iceland: evidence from Hofstaðir, Keldudalur and Skeljastaðir.

As part of a larger research project, 274 skeletons from three medieval Icelandic sites were evaluated for signs of infectious disease and 32 were found to have lesions at least consistent with a diagnosis of tuberculosis (TB): eight non-adults ranging in age from infancy to up to 17 years of age, and 24 adults. A higher proportion of individuals from Skeljastaðir and Keldudalur were affected than at Hofstaðir, an observation which may be compatible with Hofstaðir's higher status. A higher number of male skeletons overall (n. 17) than female skeletons (n. 8) exhibited pathological change. The sample is unique for its high numbers of well-preserved infants, and the appearance of TB in children is indicative of continual transmission in a community. The changes recorded in infant remains are marked by destruction and minimal periosteal new bone formation, while one adult skeleton exhibits the classic sign of Pott's disease. Other signs on the skeletons include evidence for past lymphadenitis and iliopsoas (cold) abscess. These cases indicate that TB was likely introduced to Iceland soon after the settlement period and became endemic in different regions from at least the late 10th - mid 13th centuries.

Ovarian adenocarcinoma metastasis mimicking psoas abscess on imaging: a case report.

Malignant psoas syndrome (MPS) is very rare with poor prognosis, and usually occurs in patients with advanced and recurrent cancer. Authors report herein the case of a 48-year-old female with history of neoadjuvant chemotherapy has been performed before hysterectomy with bilateral adnexectomy and ovariectomy for ovarian adenocarcinoma. She presented 18 months posttreatment with MPS due to a psoas abscess mimicking metastasis confirmed on computed tomography guided fine needle aspiration cytology.

A case of primary psoas abscess presenting as buttock abscess.

Buttock abscess is a rare clinical manifestation from unusual extrapelvic extension of psoas abscess. A 48-year-old woman presented with painful swelling of the buttock with a sense of local heat. Magnetic resonance imaging revealed a large subfascial abscess over the glutei muscles and was traced into the intraabdominal cavity over the iliac wing to the psoas muscle. Both the psoas abscess and the buttock abscess were evacuated via separate approaches. Empirical antibiotic therapy was delivered for 3 weeks. After 6 months, no evidence of recurrence was found. Psoas abscess could be included in the differential diagnosis of buttock abscess.

An iliopsoas abscess caused by Parvimonas micra: a case report.

BACKGROUND: Parvimonas micra, a Gram-positive anaerobic coccus, is a rare pathogen for psoas abscess. We describe a case of a patient with iliopsoas abscess caused by P. micra. CASE PRESENTATION: An 81-year-old Asian man presented to our department with complaints of fever since the preceding day. Abdominal computed tomography revealed the presence of a low-density mass in the right iliopsoas muscle indicative of a psoas abscess. Computed tomography-guided percutaneous drainage of the psoas abscess was performed. Results of organism cultures of the abscess and blood were positive for P. micra. However, our patient had no known primary focus of infection. On the basis of these findings, a primary psoas abscess caused by P. micra was diagnosed, and treatment with ampicillin/sulbactam 1.5 g, administered intravenously every 8 h, was initiated. By day 7, the patient's white blood cell count normalized. By day 20, his C-reactive protein level was decreased to 0.35 mg/dl. CONCLUSION: Iliopsoas abscesses caused by anaerobic bacteria are relatively rare, and iliopsoas abscesses caused by P. micra are especially rare. Our patient's case revealed that P. micra can cause iliopsoas abscess. Therefore, clinicians should be aware of the possibility that P. micra may cause iliopsoas abscess.

The effectiveness of a percutaneous endoscopic approach in a patient with psoas and epidural abscess accompanied by pyogenic spondylitis: a case report.

BACKGROUND: Psoas or epidural abscesses are often accompanied by pyogenic spondylitis and require drainage. Posterolateral percutaneous endoscopic techniques are usually used for hernia discectomy, but this approach is also useful in some cases of psoas or lumbar ventral epidural abscess. We here report a case of psoas and epidural abscesses accompanied by pyogenic spondylitis that was successfully treated by percutaneous endoscopic drainage. CASE PRESENTATION: Our patient was a 57-year-old Japanese woman who had been receiving chemotherapy for inflammatory breast cancer and who became unable to walk due to lower back and left leg pain. She was transported as an emergency to another hospital. Magnetic resonance imaging revealed psoas and epidural abscesses accompanied by pyogenic spondylitis, and methicillin-resistant Staphylococcus aureus was detected in a blood culture. Drainage of the psoas abscess was performed under echo guidance, but was not effective, and she was transferred to our institution. We performed percutaneous endoscopic drainage for the psoas and epidural abscesses. Immediate pain relief was achieved and the inflammatory reaction subsided after 8 weeks of antibiotic therapy with daptomycin. CONCLUSIONS: Percutaneous endoscopy allowed us to approach the psoas and epidural abscesses directly, enabling the immediate drainage of the abscesses with less burden on the patient.

Primary psoas abscess due to Streptococcus milleri.

Primary Psoas abscess (PPA) is an infrequent clinical entity with obscure pathogenesis and vague clinical presentation. High index of clinical suspicion is required for the diagnosis of psoas abscess. We also emphasises the importance of bacteriological confirmation of microorganism involved, although Staphylococcus aureus remains the commonest pathogen. We report an extremely rare case of PPA caused by Streptococcus milleri. Only one case has been reported in literature so far.

Spontaneous infective spondylitis and mycotic aneurysm: incidence, risk factors, outcome and management experience.

Infective spondylitis occurring concomitantly with mycotic aneurysm is rare. A retrospective record review was conducted in all cases of mycotic aneurysm from January 1995 to December 2004, occurring in a primary care and tertiary referral center. Spontaneous infective spondylitis and mycotic aneurysm were found in six cases (10.3% of 58 mycotic aneurysm patients). Neurological deficit (50% vs. 0; P < 0.001) is the significant clinical manifestation in patients with spontaneous infective spondylitis and mycotic aneurysm. The presence of psoas abscess on computed tomography (83.3% vs. 0; P < 0.001) and endplate destruction on radiography (50% vs. 0; P < 0.001) are predominated in patients with spontaneous infective spondylitis and mycotic aneurysm. Of these six patients, four with Salmonella infection received surgical intervention and all survived. Another two patients (one with Streptococcus pyogenes, another with Staphylococcus aureus) received conservative therapy and subsequently died from rupture of aneurysm or septic shock. Paravertebral soft tissue swelling, presence of psoas abscess and/or unclear soft tissue plane between the aorta and vertebral body in relation to mycotic aneurysm may indicate a concomitant infection in the spine. In contrast, if prevertebral mass is found in the survey of spine infection, coexisting mycotic aneurysm should be considered.

[Cases of pyogenic iliopsoas abscesses in military men].

Four cases of pyogenic inflammation of the iliolumbar muscle were analyzed and 3 clinical cases of this disease in military men are described. A rare case of abscess of the iliolumbar muscle complicated by secondary appendicitis is also described. A hematogenic way of infection against the background of microtraumas and hematomas with m. Iliopsoas was the main one in the patients observed that was due to specificities of military service: permanent physical activity, pustular diseases of the lower extremities. The main clinical symptom of the disease is the symptom of the iliolumbar muscle. Ultrasonic scanning is the most informative method of diagnosis among additional methods. Operative treatment of the piogenic iliopsoas abscess is the only method of treatment, the open operative interventions by the retroperitoneal access being preferred. Antibacterial therapy in the postoperative period is based on the results of inoculation of the purulent discharge from the wound. Broad spectrum antibiotics must be used due to possible anaerobic character of the purulent inflammation.