Epidural phlegmon and iliopsoas abscess caused by Salmonella enterica bacteremia: A case report

Abstract

Introduction and importance: Iliopsoas abscesses (IPA) are rare and typically present with a non-specific triad of fever, back pain, and antalgic gait. Staphylococcus aureus is the organism responsible for nearly 90 % of IPA cases. We present a case of primary IPA with progression to osteomyelitis and discitis due to Salmonella enterica bacteremia, an exceedingly rare etiology occurring in an otherwise healthy individual.

Case presentation: This patient presented with fever, back pain, and hip pain. Initial imaging and laboratory workup did not reveal any source of infection. He became septic within 72 h of admission, and blood cultures were confirmed as Salmonella enterica. However, the etiology of the infection remained unclear. Computed Tomography (CT) imaging revealed a right-sided psoas abscess measuring 7 mm × 7 mm and an epidural phlegmon. He was discharged home with intravenous ceftriaxone and levofloxacin. However, the patient was readmitted due to L2-L3 osteomyelitis and discitis with an eccentric disc bulge causing compression of the right L3 nerve root and neutropenia.

Clinical discussion: This case in unique in the fact that this occurred in a healthy patient with no significant risk factors or exposure to this bacteria. Additionally, this case highlights the rapid progression of IPA and the spread to adjacent spinal structures with the potential to cause nerve compression with successful medical management.

Conclusion: Salmonella enterica is rare cause of iliopsoas abscess. This case emphasizes the importance of including iliopsoas abscesses as a differential diagnosis in patients with a high index of clinical suspicion.

Keywords: Iliopsoas abscess; Osteomyelitis and discitis; Pancytopenia; Salmonella enterica bacteremia; sepsis.

Fig. 1

An MRI of the right hip showing a tear of the anterior labrum and osteoarthritis of the hip joint.

Fig. 2

An MRI of the pelvis without contrast showing edema in the right psoas muscle and the right-sided paraspinous muscle tissue, extending beyond the level of the imaging window.

Figs. 3 and 4

MRI of the lumbar spine showing an epidural phlegmon at the level of L3 and a right-sided psoas abscess measuring 7 mm × 7 mm.

Fig. 5

MRI showing L2-L3 osteomyelitis and discitis with an eccentric disc bulge causing compression of the traversing right L3 nerve root.