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. 2020 Aug;4(3):432-435.
doi: 10.5811/cpcem.2020.5.47020.

Atypical Cause of Sepsis from Bilateral Iliopsoas Abscesses Seeded from Self-mutilation: A Case Report

Sam Langberg  1   2 , Shayan Azizi  1
Affiliations

Atypical Cause of Sepsis from Bilateral Iliopsoas Abscesses Seeded from Self-mutilation: A Case Report

Sam Langberg et al. Clin Pract Cases Emerg Med. 2020 Aug.

Abstract

Introduction: An iliopsoas abscess (IPA) is an abscess located adjacent to the iliopsoas and iliacus muscles. Although rare, their variable clinical presentations often lead to a delay in diagnosis.

Case report: We present a case of sepsis secondary to multiple IPAs that was missed despite multiple healthcare encounters. The patient had no classical risk factors for an IPA, and the abscesses were found to be seeded via hematogenous spread from self-inflicted cutting.

Conclusion: This case illustrates the importance of obtaining a complete history, including psychiatric screen, and performing a thorough examination when evaluating patients with low back pain to rule out overlooked sources of bacteremia.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
Axial T-2 weighted magnetic resonance imaging pelvis revealing a 3.4 x 3.2 x 7.9 centimeter abscess involving the left paraspinal muscle (*).
Image 2
Image 2
Computed tomography of the abdomen and pelvis with intravenous contrast revealing a 2.7 centimeter (cm) abscess of right iliacus muscle (*). This had increased in size from 1.6 cm on initial magnetic resonance imaging. Note pigtail catheter (arrow) from drainage of left-sided iliopsoas abscess.
Image 3
Image 3
Axial T-2 weighted magnetic resonance imaging of lumbar spine after four weeks showing a recurrent abscess (*) measuring 3.2 x 1.3 centimeters. The lateral aspect of this collection extends beyond the field of view. The medial aspect of this collection appears continuous with the left sacroiliac joint (arrow), concerning for sacroilitis and possible involvement of the left iliac bone, although incompletely characterized on this study.
See this image and copyright information in PMC

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