Multiple pyogenic spondylodiscitis with bilateral psoas abscesses accompanying osteomyelitis of lateral malleolus - a case report -

Abstract

A psoas abscess is a potentially life-threatening infection. Multiple pyogenic spondylodiscitis with bilateral psoas abscesses accompanying an osteomyelitis of the lateral malleolus is an extremely rare event. We present our experience with needle aspiration for the treatment of osteomyelitis of the lateral malleolus and CT-guided percutaneous catheter drainage for a psoas abscess in an elderly patient. Both infections were completely resolved without recurrence. A psoas abscess should be included in the differential diagnosis of a patient with low back pain during musculoskeletal infection. Percutaneous needle aspiration or CT-guided percutaneous catheter drainage is an effective method for treating certain musculoskeletal infections.

Keywords: CT-guided percutaneous drainage; Osteomyelitis of lateral malleolus; Spondylodiscitis with psoas abscess.

Fig. 1

Anteroposterior radiograph shows cortical destruction of the lateral malleolar tip (arrow) and swelling of the surrounding soft tissue.

Fig. 2

(A) Technetium-99m bone scan reveals a hot uptake on the right distal fibula, (B) focal hot uptakes on L3 & L5, and subtle hot uptakes on T12 & L2.

Fig. 3

(A) T2-weighted coronal MRI reveals high signal intensities suggesting bilateral psoas abscesses (arrows) and destruction of L2-3 & L4-5 end plates, suggesting spondylodiscitis. (B) T2-weighted sagittal MRI shows multiple high signal intensities in vertebral bodies of T12 and the lumbar spine, however disc space narrowing and end plate destruction are noted on L2-3 & L4-5 levels only.

Fig. 4

An MRI scan after 4 weeks reveals complete resolution of the psoas abscesses, however irregular disc space narrowing of L2-3 and L4-5 are noted.