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Case Reports
. 2022 May 18;16(1):209.
doi: 10.1186/s13256-022-03417-4.

Primary psoas tuberculosis abscess with an iliac bone lytic lesion: a case report

Abdul Fattah Mohandes  1 , Bahjat Karam  2 , Ali Alrstom  3 , Lugien Alasadi  4 , Mohammad Wahid Rajab Bek  3 , Nizar Daher  3   5 , Tamim Alsuliman  6 , Raed Abouhareb  4
Affiliations
Case Reports

Primary psoas tuberculosis abscess with an iliac bone lytic lesion: a case report

Abdul Fattah Mohandes et al. J Med Case Rep. .

Abstract

Background: Primary psoas tuberculosis is the presence of "Koch's bacillus'' within the iliopsoas muscle caused by hematogenous or lymphatic seeding from a distant site. Muscular tuberculosis has relatively low prevalence in comparison with other cases of extrapulmonary tuberculosis, which explains the difficulties in establishing the diagnosis.

Case presentation: In this report, we present a challenging diagnostic case of primary psoas tuberculosis in a 38-year-old middle eastern female from southern Syria. The diagnosis was based on the clinical orientation, the observation of pulmonary lesions on the computed tomography scan, and the necrotic signs in the vicinity of the infected area. Despite the misleading primary false-negative results, the final diagnosis was reached after sufficient repetition of tuberculosis-specific testing. The patient was treated with isoniazid-rifampin-pyrazinamide-ethambutol for 2 months, then isoniazid and rifampin for 7 months, with full recovery in follow-up.

Conclusions: This case highlights the importance of a clinical-based approach in the treatment of patients with psoas abscesses, especially in areas with high tuberculosis prevalence.

Keywords: Abscess; Case report; Extrapulmonary tuberculosis; Ilium wing; Psoas.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Posteroanterior (A) and side view (B) of the pelvic, showing necrosis in the right iliac wing (white arrow). C Posttreatment follow-up X-ray showing the remaining necrosis in the right ileum wing (white arrow)
Fig. 2
Fig. 2
Abdominal and pelvic CT scan showing a transverse section in the Iliopsoas abscess (white star) with (A) the right kidney slightly pushed anteriorly (white arrow), (B) necrosis of the right ileum wing (white arrow), and (C) abscess in the right gluteal muscles (white arrow). The abscess extended to the right piriformis muscle (white arrow) (D) down to the level of the right obturator muscle (white arrow) (E), and the right femur adductor muscle (white arrow)(F)
Fig. 3
Fig. 3
T2 abdominal and pelvic MRI showing a cyst above the right iliac bone (white arrows) extending through it, necrosis of the ilium wing, and joint subluxation between the right head of the femur and the acetabulum due to osteomyelitis (dashed arrows)
Fig. 4
Fig. 4
Chest CT scan showing a peripheral nodule in the lower lobe of the right lung (white arrow)
See this image and copyright information in PMC

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