Spondylodiscitis with Epidural and Psoas Muscle Abscesses as Complications After Transrectal Ultrasound-guided Prostate Biopsy: Report of a Rare Case

Abstract

A 71-year-old man presented with spondylodiscitis with epidural and psoas muscle abscesses following transrectal ultrasound (TRUS)-guided prostate biopsy. These rare complications were detected by computed tomography of the abdomen and magnetic resonance imaging of the lumbar spine. The patient was successfully treated with antibiotics and underwent neurosurgery. Awareness of presentations such as backache and weakness of the lower limbs after prostate biopsy is important as these symptoms are usually mistaken for bone or muscle problems and often not recognized as being related to infection.

Learning points: We describe the case of a patient who experienced two major complications (spondylodiscitis with epidural abscess and psoas muscle abscess) following prostate biopsy.Awareness of these potential complications following prostate biopsy is essential to prevent life-threatening consequences.

Keywords: Spondylodiscitis; prostate biopsy; psoas muscle abscess; transrectal ultrasound.

Figure 1

Radiograph of the lumbar spine (sagittal view) on the 2nd day of hospitalization shows narrowing of the L3–L5 vertebrae

Figure 2

A computed tomography image of the abdomen (coronal view) during the 2nd week of hospitalization shows a cystic lesion approximately 3.3 cm in size over the right psoas muscle with wall enhancement (white arrowhead), which could not be drained via the percutaneous approach

Figure 3

Images taken on the patient’s 21st day of hospitalization. (A) Magnetic resonance image of the lumbar spine (sagittal view) shows fluid collection in the L3/4 and L4/5 intervertebral disc spaces together with narrow enhancement of the L3–L5 vertebral bodies (circle). (B) Magnetic resonance image of the lumbar spine (axial view) shows abnormally enhanced lesions involving the bilateral psoas muscles, prevertebral space and intraspinal canal (star)