Psoas muscle abscess as initial manifestation of disseminated tuberculosis in a previously healthy man: a case report

Abstract

Psoas muscle abscess is an insidious disease, with varied clinical manifestations and a challenging diagnosis. This pathology has been more frequently identified due to the increased availability of high-quality radiological imaging, such as computed tomography. In Brazil, Mycobacterium tuberculosis is the most common secondary etiologic agent of psoas abscess. We report the case of a 28-year-old immunocompetent man diagnosed with disseminated tuberculosis, affecting the lungs, lumbar spine, and psoas muscle, leading to permanent locomotion sequelae. This case is very relevant for osteoarticular complaints, as low back pain and limping were the initial symptoms. Diagnosis was confirmed by ultrasound-guided percutaneous drainage of the psoas muscle abscess and detection of the M. tuberculosis complex via Xpert MTB/RIF. A 12-month treatment with antitubercular drugs was effective.

Figure 1. Abdominal MRI showing: (A) Spondylodiscitis involving fourth and fifth lumbar vertebrae (red arrow); (B) Bulky abscess of the right ileum psoas muscle (yellow arrow).

Figure 2. Chest CT showing right lung apex with multiple central lobular nodules, in a "tree-in-bud" pattern (red arrow). Cavitated lesion with thickened walls with 1.0 cm in diameter (yellow arrow).