A Rare Case of Iliopsoas Abscess in a Term Neonate – Case Report and Brief Review of Literature

Iliopsoas abscesses are rare in neonates. Clinical presentation of neonates with iliopsoas abscess often mimic other common neonatal illness. Typical clinical features as described in adults may not be observed in neonates. Such abscesses cause a diagnostic dilemma for the clinician, often resulting in a delay in clinical diagnosis and institution of specific treatment. We report a case of a 10-day old term male neonate from community who presented with high grade fever, abdominal distension, left lower limb swelling with limitation of movement and diagnosed to have left sided iliopsoas abscess on ultrasonography. The neonate undergone and extraperitoneal surgical drainage of the abscess along with a course systemic antimicrobial agent. The case is of clinical importance because it describes the presence of a localized abscess in an uncommon location and Methicillin resistant staphylococcus being the causative organism, which represents a rare and potentially life-threatening infection in neonates.

A case report of perinephric abscess extending as psoas abscess

Iliopsoas abscess is a rare clinical entity. It is even more uncommon for psoas abscess to develop in association with genitourinary infections like perinephric abscess because of the retroperitoneal anatomy. Here we present an unusual case of a perinephric abscess extending as psoas abscess which was treated with computed tomography (CT) guided drainage.

Bilateral Primary Iliopsoas Abscess with Bilateral Hip Septic Arthritis – A Rare Case Report

Introduction:Iliopsoas abscess is an uncommon condition, often with insidious and nonspecific symptoms. Patients often present with a limp, fever, weight loss, and flank or abdominal pain. An iliopsoas abscess can be either primary or secondary depending on the presence or absence of an underlying disease. Primary abscess is very common in Asia and other developing countries. If untreated, iliopsoas abscess can spread to lower limbs, compress iliac vein, ureter and can end up in sepsis. There have been only a very small number of cases of psoas abscess with associated hip septic arthritis reported so far. Bilateral iliopsoas abscess is also a rare entity. Case Report:We report here a 58-year-old diabetic lady with fever and both hip pain subsequent to a fall at home one month back around one 1 month before. . She was initially seen elsewhere, and a diagnosis of L4-L5 disc bulge was made following which rest , analgesics and steroids were given. Later, repeat magnetic resonance imageMRI showed bilateral Iliacus abscess and bilateral hip synovitis. She was started on anti anti-tuberculosis medications and referred to us. We investigated for occult sources of infection and did bilateral iliopsoas abscess drainage followed by staged bilateral total hip replacement. She now continues to be symptom free. Conclusion: Our patient had primary bilateral iliopsoas abscess with bilateral hip Streptococcus faeeacalis septic arthritis. It has not been reported in the literature till now. Clinical Message:Early diagnosis through meticulous clinical examination and investigations is important in treatment of the abscess and reducing morbidity and mortality. Keywords:Primary iliopsoas abscess, septic arthritis, bilateral iliopsoas abscess.

Bilateral iliopsoas abscess presenting with abdominal wall cellulitis and left-sided empyema thoracis: a rare presentation

Iliopsoas abscess is common in immunocompromised patients and rarely presents with empyema thoracis. We present a 26-year-old male with no comorbidities who presented with a 3-day history of abdominal pain, fever and dyspnoea. There was no history of tuberculosis or recent contact with a tuberculous patient. On examination, the patient had facial dysmorphism and abdominal wall cellulitis extending bilaterally from flank to the inguinoscrotal region. Chest X-ray showed a left pleural effusion. Ultrasonography and contrast-enhanced CT also showed bilateral iliopsoas abscess with a left massive pleural empyema. The patient underwent bilateral abscess open drainage, thoracostomy for left empyema thoracis and intravenous antibiotic therapy. The patient had an uneventful course postoperatively and was discharged.

Diagnostic dilemma of primary neonatal iliopsoas abscess

Background Primary iliopsoas abscess is extremely rare in neonates and overlooked easily. It is potentially curable with surgical drainage and broad-spectrum antibiotics if diagnosed early. Case presentation A 13-day-old neonate was presented with a swelling and bluish discoloration on the left thigh and groin. There was a restriction of movement of the left lower limb, and he developed high grade fever later on, during hospital stay. In spite of a great dilemma, we could finally reach the diagnosis of primary iliopsoas abscess, performed surgical drainage, and controlled ongoing sepsis. At 3 months follow-up, the patient was doing well and there was no asymmetry in appearance of movements. Conclusion High index of suspicion, vigilant clinical examinations, and targeted laboratory investigations with imaging studies are of paramount importance in establishing its diagnosis. This case highlights the diagnostic difficulties and re-evaluates the representative features of neonatal iliopsoas abscess and its management.

Iliopsoas Abscess in Children – A Forgotten Diagnosis

Iliopsoas abscess is a rare diagnosis in children. We recently encountered two cases which were managed at our institution. A 11-year female presented with thigh and inguinal swelling while 3-year male child presented with limp and fixed flexion deformity of right leg. Due to the differing presentation, imaging studies are often important before management is planned. Ultrasound scan is the most common investigation followed by computerized tomography (CT) scan in a selected few. The girl underwent a CT scan followed by incision and drainage (I&D) of the iliopsoas abscess while the boy underwent ultrasound-guided pigtail catheter insertion. Both cases were successfully treated. Atypical presentation of iliopsoas abscess makes the diagnosis difficult and requires a high degree of clinical suspicion for making correct diagnosis. Imaging studies help with diagnosis in such cases. Less invasive techniques like image-guided aspiration and catheter drainage can be helpful in carefully selected cases. Keywords: Iliopsoas abscess, Atypical presentation, Percutaneous drainage, Pediatric.

Iliopsoas Abscess

Iliopsoas abscess (IPA) is uncommon condition in children, diagnosis might be delayed because of nonspecific signs and symptoms. Only few patients have classical clinical triad at presentation in the form of fever, back pain, and inguinal pain at hip flexion. The diagnosis most likely to be reached in the first time by the use of abdominal computed tomography (CT) scan. We present a Saudi child with nonspecific signs and symptoms of fever, flank pain, and limping who was diagnosed as IPA by abdominal ultrasound and CT scan. The case was managed with intravenous antibiotics along with transcutaneous abscess drainage. doi: https://doi.org/10.12669/pjms.37.2.3816 How to cite this:Sobaih B, Sobaih L, Al-Zamil F. Iliopsoas Abscess. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3816 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.