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Abstract Background Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of considering iliopsoas abscess in patients presenting with fever and hip pain, especially in the absence of obvious risk factors or penetrating trauma. The novelty of this case lies in its atypical presentation mimicking a respiratory viral infection and musculoskeletal injury, impeding accurate diagnosis and appropriate management. Case Presentation A previously healthy 21-year-old female who had a mechanical fall 3 weeks prior presented with fever, right hip pain, and respiratory symptoms, initially suggestive of a respiratory infection and musculoskeletal injury. However, initial investigations revealing a markedly high C-reactive protein (CRP) concentration prompted further computed tomography (CT) imaging of her abdomen and pelvis, which uncovered an iliopsoas abscess presumably stemming from antecedent trauma. Subsequent CT guided aspiration along with culture-sensitive antibiotics led to successful treatment and resolution of her symptoms. Conclusions This case emphasizes the importance of considering iliopsoas abscess as a possible differential, even in young patients without typical risk factors. Markedly elevated inflammatory markers such as CRP concentrations can serve as a vital indicator, directing attention towards the possibility of septicemia or the presence of an occult abscess, facilitating prompt imaging and accurate diagnosis.

Background: Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of considering iliopsoas abscess in patients presenting with fever and hip pain, especially in the absence of obvious risk factors or penetrating trauma. The novelty of this case lies in its atypical presentation mimicking a respiratory viral infection and musculoskeletal injury, impeding accurate diagnosis and appropriate management. Case Presentation: A previously healthy 21-year-old female who had a mechanical fall 3 weeks prior presented with fever, right hip pain, and respiratory symptoms, initially suggestive of a respiratory infection and musculoskeletal injury. However, initial investigations revealing a markedly high C-reactive protein (CRP) concentration prompted further computed tomography (CT) imaging of her abdomen and pelvis, which uncovered an iliopsoas abscess presumably stemming from antecedent trauma. Subsequent CT guided aspiration along with culture-sensitive antibiotics led to successful treatment and resolution of her symptoms. Conclusions: This case emphasizes the importance of considering iliopsoas abscess as a possible differential, even in young patients without typical risk factors. Markedly elevated inflammatory markers such as CRP concentrations can serve as a vital indicator, directing attention towards the possibility of septicemia or the presence of an occult abscess, facilitating prompt imaging and accurate diagnosis. [ABSTRACT FROM AUTHOR]

We report the case of a 22-day-old boy baby, and he was brought to us with fever and vague rapidly growing mass in the lower abdomen eventually diagnosed as iliopsoas abscess (IPA). Ultrasonography (USG) and computed tomography were of help in making diagnosis. USG-guided aspiration failed; hence, the baby was treated by extraperitoneal drainage. IPA in neonates is uncommon. This rare disease presentation with confined review of literature is set out in this case report.

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection, typically caused by preexisting conditions such as trauma, complicated intraabdominal infections, or even small wounds. However, it is very rare for NF to occur as a result of perforated colon cancer (CC). Diagnosis primarily relies on clinical findings, imaging, and laboratory tests. Early diagnosis and treatment are crucial for patient survival. In this study, we present a case of an 82-year-old female a known case of CC diagnosed 1 month ago. She presented with hip pain persisting for 10 days duration, along with skin changes over the proximal anterolateral aspect of the thigh. The patient was diagnosed with NF associated with an iliopsoas abscess caused by perforated CC that was managed with surgical debridement, left hemicolectomy, and end colostomy along with broad-spectrum antibiotics. [ABSTRACT FROM AUTHOR]

Abstract Background Malignant lymphoma rarely mimics an infected arterial aneurysm and a ruptured arterial aneurysm because of similar imaging findings, leading to misdiagnosis. The hematomas of ruptured aneurysms are radiologically difficult to distinguish from those of malignant lymphoma in emergency settings. Hence, a definitive diagnosis is crucial to avoid unnecessary surgery. Case presentation A man in his 80s with hematuria and shock vital had right internal iliac artery aneurysm (IIAA) and perianeurysmal fluid retention, which appeared to be a ruptured or an infected aneurysm. Treatment was initiated for infected IIAA instead of for ruptured IIAA. Systemic inflammatory response syndrome developed, and the infectious sources were assessed. Pacemaker lead and urinary tract infections were identified and treated; however, blood pressure was unstable. The aneurysm was treated with endovascular aortic aneurysm repair following antibiotic therapy; however, fluid retention increased, and inflammatory status and hematuria deteriorated. Open surgical conversion was performed to manage the infected lesions. Although an iliopsoas abscess was detected during surgery and nephrectomy and ureterectomy were performed to control the hematuria, analysis of the removed tissues led to the pathological diagnosis of diffuse large B-cell lymphoma (DLBCL). Conclusions We encountered a case of DLBCL with imaging findings mimicking an infected internal iliac artery aneurysm, and definitive diagnosis was made more than 2 months after the initial examination. Definitively diagnosing malignant lymphoma around an iliac artery aneurysm based merely on symptoms and imaging findings is extremely difficult. Thus, histological examination should be actively performed in atypical infected aneurysms.

Abstract Background Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. Case presentation This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. Conclusions Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

We report the case of a 22-day-old boy baby, and he was brought to us with fever and vague rapidly growing mass in the lower abdomen eventually diagnosed as iliopsoas abscess (IPA). Ultrasonography (USG) and computed tomography were of help in making diagnosis. USG-guided aspiration failed; hence, the baby was treated by extraperitoneal drainage. IPA in neonates is uncommon. This rare disease presentation with confined review of literature is set out in this case report. [ABSTRACT FROM AUTHOR]

Key Clinical Message This case highlights the importance of early diagnosis of iliopsoas abscess in patients with communication difficulties and appropriate treatment to prevent further complications. Abstract We report a case in which the detection of an iliopsoas abscess was delayed due to difficulty in communication but was successfully treated with percutaneous drainage. A 70‐year‐old man with a 38–39°C fever and 5.69 mg/dL C‐reactive protein. Adult‐onset Alexander's illness, affected his swallowing, speech, coordination, and motor function. Abdominal computed tomography revealed a big iliopsoas abscess. Antibacterial treatment followed percutaneous draining. Drainage reduced temperature and inflammation. Four months later, the iliopsoas abscess returned, the second drainage eliminated recurrence. Difficulty in communicating was a contributing factor to the delayed diagnosis of a giant iliopsoas abscess. In the treatment of such patients, percutaneous drainage seems effective as an initial therapy.

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.

Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnose due to vague clinical presentation. Early treatment with drainage and appropriate antibiotic therapy is necessary before sepsis sets in and become lethal. We conducted this study to evaluate clinical features, etiology, management strategies, and outcomes in patients with IPA from a University Teaching Hospital in Nepal.

Background: Malignant lymphoma rarely mimics an infected arterial aneurysm and a ruptured arterial aneurysm because of similar imaging findings, leading to misdiagnosis. The hematomas of ruptured aneurysms are radiologically difficult to distinguish from those of malignant lymphoma in emergency settings. Hence, a definitive diagnosis is crucial to avoid unnecessary surgery. Case presentation: A man in his 80s with hematuria and shock vital had right internal iliac artery aneurysm (IIAA) and perianeurysmal fluid retention, which appeared to be a ruptured or an infected aneurysm. Treatment was initiated for infected IIAA instead of for ruptured IIAA. Systemic inflammatory response syndrome developed, and the infectious sources were assessed. Pacemaker lead and urinary tract infections were identified and treated; however, blood pressure was unstable. The aneurysm was treated with endovascular aortic aneurysm repair following antibiotic therapy; however, fluid retention increased, and inflammatory status and hematuria deteriorated. Open surgical conversion was performed to manage the infected lesions. Although an iliopsoas abscess was detected during surgery and nephrectomy and ureterectomy were performed to control the hematuria, analysis of the removed tissues led to the pathological diagnosis of diffuse large B-cell lymphoma (DLBCL). Conclusions: We encountered a case of DLBCL with imaging findings mimicking an infected internal iliac artery aneurysm, and definitive diagnosis was made more than 2 months after the initial examination. Definitively diagnosing malignant lymphoma around an iliac artery aneurysm based merely on symptoms and imaging findings is extremely difficult. Thus, histological examination should be actively performed in atypical infected aneurysms. [ABSTRACT FROM AUTHOR]

(1) Background: Iliopsoas abscess (IPA) is usually overlooked due to its nonspecific symptoms and signs. The resulting delayed diagnosis and treatment can increase morbidity and mortality. The purpose of the present study was to identify the risk factors for the unfavorable outcomes associated with IPA. (2) Methods: We included patients who presented to the emergency department and were diagnosed with IPA. The primary outcome was in-hospital mortality. Variables were compared, and the associated factors were examined with Cox proportional hazards model. (3) Results: Of the 176 patients enrolled, IPA was of primary origin in 50 patients (28.4%) and of secondary origin in 126 (71.6%). Skeletal origin was the most common source of secondary IPA (n = 92, 52.3%). The most common pathogens were Gram-positive cocci. Eighty-eight (50%) patients underwent percutaneous drainage, 32 (18.2%) patients underwent surgical debridement, and 56 (31.8%) patients received antibiotics. Multivariate analyses indicated that age > 65 (year) (HR = 5.12; CI 1.03–25.53; p = 0.046), congestive heart failure (HR = 5.13; CI 1.29–20.45; p = 0.021), and platelet < 150 (103/μL) (HR = 9.26; CI 2.59–33.09; p = 0.001) were significant independent predictors of in-hospital mortality in Model A, while the predictors in Model B included age > 65 (year) (HR = 5.12; CI 1.03–25.53; p = 0.046) and septic shock (HR = 61.90; CI 7.37–519.46; p < 0.001). (4) Conclusions: IPA is a medical emergency. Our study reported that patients with advanced age, congestive heart failure, thrombocytopenia, or septic shock had a significantly higher risk of mortality, and the recognition of the associated factors may aid in risk stratification and the determination of the optimal treatment plan for IPA patients. [ABSTRACT FROM AUTHOR]

Background: Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. Case presentation: This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. Conclusions: Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case highlights the importance of early diagnosis of iliopsoas abscess in patients with communication difficulties and appropriate treatment to prevent further complications. We report a case in which the detection of an iliopsoas abscess was delayed due to difficulty in communication but was successfully treated with percutaneous drainage. A 70‐year‐old man with a 38–39°C fever and 5.69 mg/dL C‐reactive protein. Adult‐onset Alexander's illness, affected his swallowing, speech, coordination, and motor function. Abdominal computed tomography revealed a big iliopsoas abscess. Antibacterial treatment followed percutaneous draining. Drainage reduced temperature and inflammation. Four months later, the iliopsoas abscess returned, the second drainage eliminated recurrence. Difficulty in communicating was a contributing factor to the delayed diagnosis of a giant iliopsoas abscess. In the treatment of such patients, percutaneous drainage seems effective as an initial therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Iliopsoas abscess is a relatively rare but serious infectious disease. Infectious disease is one of the major causes of death among patients receiving hemodialysis for end-stage renal disease (ESRD). Case presentation We experienced three cases of iliopsoas abscess in patients receiving hemodialysis. The infection route was distinct in each case. A 79-year-old woman with ESRD due to autosomal dominant polycystic kidney disease exhibited bilateral iliopsoas abscesses caused by bacterial contamination during a lumbar epidural block procedure. A 60-year-old woman with ESRD due to diabetic nephropathy was diagnosed as having an iliopsoas abscess, caused by the direct invasion of bacteria from a renal abscess. A 78-year-old woman who started hemodialysis because of nephrosclerosis developed an iliopsoas abscess caused by the hematogenous spread of bacteria from emphysematous cystitis. All three cases were treated with antibiotics and/or percutaneous drainage. A survey of published reports suggested that iliopsoas abscess can be caused by infection through a variety of routes in hemodialysis patients. Conclusion Because hemodialysis patients are at a high risk of infection because of their immunocompromised state, physicians should pay close attention to infection prevention. If iliopsoas abscess is suspected, examinations such as computed tomography, magnetic resonance imaging, and blood culture sampling should be conducted promptly, followed by appropriate treatment with antibiotics and/or drainage.

Background: In most cases, ingested foreign bodies pass in alimentary tract silently. Rarely, ingested foreign bodies enter vermiform appendix. However, when it happened, they cannot reenter alimentary tract and may result in an inflammatory process. We report a case of iliopsoas abscess secondary to ingested metallic foreign body penetrating appendix. Case presentation: A 2-year-old child presented to our unit with her mother complaining that her child developed fever, repeated vomiting, and abdominal distension after one week of accidently ingestion of a rusty veil pin. Abdominal examination revealed right iliac tenderness and rebound tenderness. Abdominal ultrasound and multi-slice computer topography (MSCT) with intravenous contrast and gastrograffin enema revealed right iliopsoas abscess and metallic foreign body piercing appendicular wall with its tip seen in the iliopsoas abscess. We do appendectomy via transabdominal approach with good drainage of the abscess cavity. We discharged our patient on the fifth day postoperatively. Conclusions: The ingestion of inedible and indigestible objects is frequent in children. In most cases, ingested foreign bodies (FB) pass in alimentary tract silently. Rarely, ingested foreign bodies enter vermiform appendix and if it happened it may result in devastating complications as iliopsoas abscess. The is necessary to increase awareness of potential complications of ingested foreign bodies, especially in children.

Musculoskeletal tuberculosis represents 1% of total tuberculosis cases. It affects young adults from endemic countries or immunocompromised patients and may lead to severe functional impairment. We report a case of a 27-year-old male from an endemic country presenting with a 4-month history of fever, a major pectoralis abscess, and low back pain. A lumbar spine MRI revealed osteolytic lesions in multiple vertebral bodies along with a large iliopsoas abscess. Both abscesses were drained and the diagnosis was established by positive polymerase chain reaction assay for tuberculosis. The patient was initiated on anti-tuberculous treatment for 9 months. Musculoskeletal tuberculosis is rarely found in Western countries. If left untreated, it can lead to severe complications which may require surgical intervention. [ABSTRACT FROM AUTHOR]

Inguinal masses are common presentations in clinical practice, often attributed to hernias. However, atypical features may lead to diagnostic difficulties and delayed intervention. We present a case of a 32-year-old Ethiopian woman with a prolonged history of a growing groin mass 2 months following childbirth, her diagnosis potentially challenged by her recent obstetric history. Despite previous evaluations suggesting inguinal hernia, her symptoms worsened, prompting an emergency department visit. Further investigation revealed an unexpected diagnosis of intraabdominal tuberculosis, manifesting as a large iliopsoas abscess. This case underscores the importance of considering uncommon etiologies in the differential diagnosis of inguinal masses, particularly in high-risk populations with comparable situations, to ensure timely diagnosis and intervention., Competing Interests: The authors declare no conflicts of interest related to this work., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Iliopsoas abscesses are a rare complication of appendicitis and are associated with high morbidity and mortality without appropriate intervention. Current literature provides sufficient evidence for managing psoas abscesses via antimicrobial therapy, CT-guided percutaneous drainage, and laparoscopic or open drainage as primary approaches. However, there is insufficient data in the current literature for assessing improved patient outcomes with robotically assisted laparoscopic drainage as an approach to treatment. Here, we present the case of a 72-year-old male with a prior history of perforated appendicitis complicated by a pelvic abscess and treated interventional radiology (IR)-guided drain, left partial nephrectomy secondary to renal cell carcinoma, and bilateral hip arthroplasty presenting with signs and symptoms of recurrent appendicitis. CT imaging found a loculated right iliopsoas abscess adjacent to the appendix, which was not amenable to IR percutaneous drainage. Surgical drainage was deemed necessary with a robotically assisted approach, and the patient had improved clinical status after the intervention. Early results show that robotically assisted laparoscopic surgery has been shown to shorten the clinical course for patients via decreased length of stay, faster recovery times, and better incisions cosmetically. Drainage via robotic laparoscopy allows for complete drainage and irrigation, maximizing source control of infection. It is an effective approach for the management of refractory psoas abscesses secondary to appendicitis., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ferrer Ocampo et al.)

Hip pain in children and adolescents poses a diagnostic challenge due to various underlying causes, ranging from benign to severe conditions. Presented here is the case of an otherwise healthy 14-year-old boy who arrived at the emergency department with a two-day history of left hip pain, limping, fever, anorexia, and vomiting. Upon physical examination, tenderness was noted upon palpation of the left sacroiliac joint and with mobilization of the left lower limb. Elevated inflammatory markers raised suspicion of an osteoarticular infection. Despite initially normal imaging, subsequent MRI revealed an iliopsoas abscess, later confirmed by blood cultures positive for  Staphylococcus aureus . A conservative management with antibiotics was selected due to the infeasibility of percutaneous or surgical drainage, leading to clinical improvement. This case highlights the efficacy of non-surgical approaches in selected situations and underscores the importance of a thorough evaluation, early suspicion of infection, appropriate imaging, and tailored antimicrobial therapy in managing hip pain in pediatric patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lages Pereira et al.)

Background: Iliopsoas abscess, though usually presents with innocuous features, may sometimes complicate the clinical course with neurologic complications or hyperacute symptoms. Occasionally it may extend to the epidural space causing the surgical emergency of cauda equina syndrome, with clinical symptoms of saddle anesthesia, motor and sensory dysfunction of lower limbs, as well as bowel/bladder dysfunction. Case report: We present the case of a patient with iliopsoas abscess who presented with acute low back pain and radiculopathy, which over a period of few hours progressed to incomplete cauda equina syndrome. The patient was managed with urgent posterior decompression of the communicating epidural abscess and drainage of iliopsoas abscess. At final follow-up of one year, complete resolution of neurological deficit was evident. Conclusion: Iliopsoas abscess, depending upon the virulence of the causative microbe, may rarely extend to the epidural space causing surgical emergency of cauda equina syndrome. Urgent surgical decompression of nerve root and dural sac, and evacuation of pus can yield satisfactory clinical outcome. Level of evidence: Level V.

Musculoskeletal tuberculosis represents 1% of total tuberculosis cases. It affects young adults from endemic countries or immunocompromised patients, and may lead to severe functional impairment. We report a case of a 27-year-old male from an endemic country presenting with a 4-month history of fever, a major pectoralis abscess, and low back pain. A lumbar spine MRI revealed osteolytic lesions in multiple vertebral bodies along with a large iliopsoas abscess. Both abscesses were drained and the diagnosis was established by positive polymerase chain reaction assay for tuberculosis. The patient was initiated on anti-tuberculous treatment for 9 months. Musculoskeletal tuberculosis is rarely found in Western countries. If left intreated, it can lead to severe complications which may require surgical intervention.

Abstract 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.

Introduction: Rhabdomyosarcoma (RMS) is a soft tissue tumor arising from myogenic precursor cells. RMS involving the spine primarily is rare, with only few such reported cases. Clinical image report: A 43 year old gentleman had complains of low back pain, weakness of lower limbs and urinary incontinence for three months. With radiological and histopathological investigations, the patient was diagnosed as alveolar type of RMS. Conclusion: Identifying the histological type of RMS pave a way for the treatment plan and to prognosticate the disease activity.

IntroductionIliopsoas abscess with septicemia in the pediatric population is rare. Early diagnosis and effective management of this emergent disorder remain challenging for clinicians.Case PresentationA 14-year-old girl presented with right lateral and posterior hip pain and fever for 7 days before admission. Blood culture was positive for Staphylococcus aureus. Enhanced magnetic resonance imaging revealed abscesses located in the right iliopsoas muscle and on the surface deep to the fascia of the right sacroiliac joint that were 6.8 cm × 6.2 cm × 5.7 cm and 3.7 cm × 3.5 cm × 2.1 cm, respectively. A diagnosis of right iliopsoas abscesses with septicemia was made. The patient received intravenous antibiotics, underwent ultrasound-guided percutaneous catheter drainage, and recovered uneventfully. Medical literature regarding this issue published in the English language during the last two decades was reviewed.DiscussionPrimary synchronous psoas and iliacus muscle abscesses are rare and emergent disorders in the pediatric age group. The diagnosis is generally delayed owing to the deep anatomic location and nonspecific signs and symptoms. A comprehensive medical history, meticulous physical examination, and judicious use of imaging studies could establish a timely and accurate diagnosis. Surgeons should be aware of the occurrence of multiple abscesses. Prompt and adequate antibiotic therapy accompanied by a mini-invasive approach, such as ultrasound-guided, laparoscopic, or video-retroperitoneoscopic drainage of the infectious focus, if indicated and feasible, is important to achieve a good outcome in the management of iliopsoas abscess.

Hypermucoviscous Klebsiella pneumoniae (hmKP) is a bacterium known to cause lesions, including abscesses, in various organs. Unlike typical Klebsiella pneumoniae , hmKP can yield a positive string test in culture specimens. Infections caused by hmKP often become severe and are associated with a poor prognosis. In this report, we describe a case of iliopsoas abscess, spondylodiscitis, septic pulmonary embolism, and symmetrical peripheral gangrene (SPG) caused by hmKP. The patient received non-invasive positive-pressure ventilation, hemodialysis, platelet transfusions, fresh frozen plasma, thrombomodulin, and intensive antibiotic therapy including rifampicin. The patient underwent 148 days of antibiotic therapy and achieved a good outcome., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hamada et al.)

We experienced a rare case in which iliopsoas abscess (IPA), caused by an Extended Spectrum β-Lactamase (ESBL)-producing Proteus mirabilis, perforated and communicated with the ureter and caused sepsis. An 84-year-old woman, bedridden due to sequelae of a cerebral hemorrhage, was brought to our hospital with a chief complaint of fever lasting for 3 weeks. Computed tomography (CT) revealed a huge 180 × 110 × 100 mm IPA in the right iliopsoas muscle. The ureter was also found to communicate with the iliopsoas muscle abscess, ureteral stenosis was detected at the same site, and dilatation of the renal pelvis occurred above the area of the ureteral stenosis, indicating hydronephrosis. Considering the mechanism of this case, if the ureter first ruptures and urine leaks, followed by the formation of an IPA, urine will flow along the surrounding fatty tissue and cause an abscess around the ureter and kidney. However, because almost no abscess was detected around the ureter, the abscess was thought to have originated from the iliopsoas muscle located near the center of the ureter. In summary, in this case, an abscess first formed within the iliopsoas muscle, which gradually expanded and compressed the right ureter, resulting in hydronephrosis. The upper ureter, which had become dilated and thinned due to ureteral obstruction, became even more fragile because of the spread of inflammation from the IPA, and the IPA perforated and communicated with the ureter. In patients who have difficulty communicating, the diagnosis of IPA may be delayed because the only symptom is fever. As in this case, if the diagnosis is delayed, the abscess may become large and perforate the ureter; thus, IPA should always be considered as a cause of fever of unknown origin., Competing Interests: None, (Copyright © Japan Medical Association.)

A 29-year-old Japanese man with a history of right-sided tuberculous pleurisy presented with fever and right flank pain. Computed tomography images revealed a right pleural effusion and an area of low attenuation in the right iliopsoas muscle. Percutaneous drainage of the iliopsoas lesion resulted in a bloody pyogenic discharge that tested positive for Mycobacterium tuberculosis by both acid-fast staining and polymerase chain reaction. Enhanced fluoroscopy revealed a perforation of the diaphragm between the thoracic region and the psoas muscle. The patient was diagnosed with an iliopsoas abscess secondary to tuberculous empyema.

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. [ABSTRACT FROM AUTHOR]

Iliopsoas abscesses (IPAs) associated with bowel obstruction due to colon cancer are rare, and there is no consensus regarding treatment strategies. A 63-year-old man presented with swelling and pain in the right iliac region. Imaging studies revealed an IPA expanding from the psoas major muscle and retroperitoneal space subcutaneously around the right ilium. After percutaneous drainage, the patient developed bowel obstruction secondary to colon cancer. Hemicolectomy and preventive ileostomy were performed at the gastrointestinal surgery department, and chemotherapy was administered at the medical oncology department after ileostomy closure. Three months later, local recurrence was confirmed in the right iliac region, and the recurrent lesion, including the ilium, was widely resected. One and a half years after the reoperation, there was no recurrence. An IPA due to colorectal cancer without obvious perforation can also occur, and the treatment of IPAs depends on their size, location, shape, and presence of gas. Minimally invasive and staged treatment is preferable for IPAs due to colorectal cancer because the surgical mortality rate for colorectal cancer with local abscesses is high. Colorectal cancer should be considered as a cause of IPAs. Treatment of IPAs caused by colon cancer should be performed in a less invasive manner after considering their size, location, shape, and the presence of gas. Cooperation between gastrointestinal surgeons and oncologists is essential for managing patients with an IPA due to colon cancer complicated by bowel obstruction. • We report a rare case of iliopsoas abscess due to colon cancer. • The patient developed bowel obstruction after percutaneous abscess drainage. • Hemicolectomy and chemotherapy were performed in the relevant departments. • Recurrent lesions, including those in the bone, were widely resected. • A less invasive technique for abscess drainage and staged surgery should be chosen. [ABSTRACT FROM AUTHOR]

Iliopsoas abscess presents with vague and variable symptoms and is less commonly encountered in a clinical setting. The most common causative agent is staphylococcus aureus. In our case, a 2-year-old boy presented with high-grade fever, difficulty in walking, and pain in the right leg near the hip joint. Psoas sign was positive but his blood cultures were negative and CT scan showed a necrotic mass with peripheral enhancement measuring 7.0x4.2x2.6 cm in all three dimensions in right Psoas muscle. Biopsy of the abscess was denied and the patient was managed conservatively with intravenous ceftriaxone and metronidazole. This case highlights the importance of clinical examination and then co-relating it radiologically and focuses on the importance of broadspectrum antibiotics when necessary investigation (biopsy in our case) is denied.

Abstract Background Iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment. It can be primary or secondary in origin. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site. This is commonly associated with a chronic immunocompromised state and tends to occur in children and young adults. Secondary iliopsoas abscess occurs as a result of the direct spread of infection to the psoas muscle from an adjacent structure, and this may be associated with trauma and instrumentation in the inguinal region, lumbar spine, or hip region. The incidence of iliopsoas abscess is rare and often the diagnosis is delayed because of non-specific presenting symptoms. Case presentation We describe a patient with iliopsoas abscess who presented to the Emergency Department at X Hospital on three separate occasions with non-specific symptoms of thigh pain and fever before finally being admitted for treatment. This case illustrates how the diagnosis can be delayed due to its atypical presentation. Hence, highlighting the need for clinicians to have a high index of clinical suspicion for iliopsoas abscess in patients presenting with thigh pain and fever. Conclusion The classic triad of fever, flank pain, and hip movement limitation is presented in only 30% of patients with iliopsoas abscess. Clinicians should consider iliopsoas abscess as a differential diagnosis in patients presenting with fever and thigh pain. The rare condition with the varied clinical presentation means that cross-sectional imaging should be considered early to reduce the risk of fulminant sepsis.

Very few imaging techniques can demonstrate the presence of Mycobacterium tuberculosis in vivo. Technitium-99m Ethambutol scintigraphy is one of them, although literature on the utility of this technique is scarce. We describe a patient with iliopsoas abscess showing increased uptake on Tc-99 m ethambutol scintigraphy which was later confirmed to be tubercular by the microbiological analysis of pus. [ABSTRACT FROM AUTHOR]

Iliopsoas abscess is a rare medical infection disease. Clinical finding was fluid or/with pus accumulated inside the iliopsoas muscle compartment. Most cases of iliopsoas abscess were unilateral site. Bilateral iliopsoas abscesses were rare and also difficult to treat clinically. Antibiotics alone or /with traditional percutaneous image-guided drainage such as Ultrasound-guided or Computerized Tomography-guided is a standard treatment. We describe a 41-year-old patient with bilateral iliopsoas abscess who presented to the Emergency Department with both lower legs pain. Computed tomography and Magnetic Resonance Imaging revealed the presence of bilateral low-density masses in bilateral iliopsoas muscle area indicative of bilateral iliopsoas abscesses. Antibiotics had been applied and Ultrasound-guided or Computerized Tomography-guided percutaneous drainage was recommended. Due to poor clinical assessment of traditional percutaneous image-guided drainage, we performed minimal open surgical drainage with Navigation-guided system. Iliopsoas abscess can be treated successfully with antibiotics alone or/with percutaneous image-guided drainage. Minimally open for surgical drainage with Navigation-guided system could be an effective and safe alternative optional method. To our knowledge, this is the first report of bilateral iliopsoas abscess with definitive drainage under minimally open for surgical drainage via Navigation-guided system.

We describe the case of a 65-year-old patient who presented to our hospital with femoral pain. MRI and CT scan revealed a retroperitoneal abscess. We treated him with early surgical drainage and antibiotic treatment. The urine and draining pus cultures grew Achromobacter xylosoxidans. An iliopsoas abscess may show unique signs depending on its volume. To the best of our knowledge, this is the second reported case of retroperitoneal abscesses due to A. xylosoxidans. Surgical drainage appears to be effective when abscess is large.

A 77-year-old African American female with rheumatoid arthritis presented with fever and unsteady gait. She was started on broad-spectrum antimicrobials due to CT evidence for sacroiliitis and psoas abscess and underwent partial excision of her sacroiliac bone and drainage of the abscess. One of four blood cultures grew Enterococcus faecalis and the patient was sent home with intravenous ampicillin for 6 weeks. Two days after antimicrobial completion, the patient presented with night sweats and weakness. Chest x-ray revealed new right upper lobe pulmonary infiltrates, and the AFB culture sent during her prior admission returned positive for TB. RIPE therapy with moxifloxacin was initiated. Although she responded well to treatment, she retained functional immobility. We report a case of musculoskeletal TB initially misdiagnosed as enterococcus sacroiliitis, resulting in a delayed initiation of anti-tuberculous therapy. A high index of suspicion and rapid detection with TB-PCR testing should be considered to avoid delayed diagnosis.

A newborn baby with an unusual complaint of transient left leg cyanosis during crying, who was diagnosed with a iliopsoas abscess is presented. Newborn cases diagnosed with an iliopsoas abscess in the English literature are summarized and differences in clinical presentations are discussed. [ABSTRACT FROM AUTHOR]

We present a case of iliopsoas abscess secondary to inflammatory bowel disease associated to glycogen storage disease 1b in a 12-year-old boy. To the best of our knowledge, a similar case has not been reported in medical literature.

A 29-year-old Japanese man with a history of right-sided tuberculous pleurisy presented with fever and right flank pain. Computed tomography images revealed a right pleural effusion and an area of low attenuation in the right iliopsoas muscle. Percutaneous drainage of the iliopsoas lesion resulted in a bloody pyogenic discharge that tested positive for Mycobacterium tuberculosis by both acid-fast staining and polymerase chain reaction. Enhanced fluoroscopy revealed a perforation of the diaphragm between the thoracic region and the psoas muscle. The patient was diagnosed with an iliopsoas abscess secondary to tuberculous empyema. [ABSTRACT FROM AUTHOR]

Primary iliopsoas abscess (IPA) is rare in the infantile period. However, if treatment is not initiated soon, aggressive, and adequate, there is high risk for mortality or permanent damage to the hip joints. We present the case of a preterm neonate who presented at 2 months of age with swelling and restricted movements of the left leg for the past 1 week. A diagnosis of idiopathic left IPA was made due to Staphylococcus aureus which was drained surgically and treated with systemic antibiotics. Currently, the baby is 6 months old with no evidence of any sequelae.

Background: Retroperitoneal Abscess (RA) is a rare and often insidious disease, i.e., difficult to diagnose. RA could originate from different retroperitoneal or intra-abdominal organs. The disease manifests various clinical symptoms and is usually treated with a combination of antibiotics and therapeutic interventions. Methods: Data from a total of 25 patients who were admitted to Loghman Hospital in Tehran City, Iran with a diagnosis of RA from 2010 to 2020 were reviewed in this research. Clinical findings, diagnostic tools, treatment approaches, and microbiology data were considered and analyzed. Results: Out of the 25 patients, the most frequent sources of RA were primary infections (36%), followed by gastrointestinal origin (20%). Fifty-two percent of patients presented no underlying disease; however, diabetes mellitus was the most prevalent underlying disease in the remaining ones. Fever, chills, and back or flank pain (56%) were the most common symptoms in the studied patients. Besides, a high erythrocyte sedimentation rate (mean: 93.58%) was found in most of the researched patients. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) could reliably diagnose the disease with an accuracy of 100% and 92.3%, respectively. Seventy-two percent of the study patients eventually underwent surgery. By taking advantage of CT scan, 24% of abscesses were drained and only 4% required medications to achieve remission. Mycobacteria and Klebsiella pneumonia were the most prevalent pathogens among the explored patients. The total mortality rate was equal to 12%; it occurred in cases with RA of a gastrointestinal (8%) or genitourinary (4%) origin. Conclusion: There exist 3 major choices for treating abscesses, including surgery, image-guided percutaneous drainage, and medical therapy. Image-Guided drainage is recommended in primary infections; however, extra-peritoneal surgery is useful to treat secondary infections, especially those of a gastrointestinal source.

Background: Iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment. It can be primary or secondary in origin. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site. This is commonly associated with a chronic immunocompromised state and tends to occur in children and young adults. Secondary iliopsoas abscess occurs as a result of the direct spread of infection to the psoas muscle from an adjacent structure, and this may be associated with trauma and instrumentation in the inguinal region, lumbar spine, or hip region. The incidence of iliopsoas abscess is rare and often the diagnosis is delayed because of non-specific presenting symptoms.Case Presentation: We describe a patient with iliopsoas abscess who presented to the Emergency Department at X Hospital on three separate occasions with non-specific symptoms of thigh pain and fever before finally being admitted for treatment. This case illustrates how the diagnosis can be delayed due to its atypical presentation. Hence, highlighting the need for clinicians to have a high index of clinical suspicion for iliopsoas abscess in patients presenting with thigh pain and fever.Conclusion: The classic triad of fever, flank pain, and hip movement limitation is presented in only 30% of patients with iliopsoas abscess. Clinicians should consider iliopsoas abscess as a differential diagnosis in patients presenting with fever and thigh pain. The rare condition with the varied clinical presentation means that cross-sectional imaging should be considered early to reduce the risk of fulminant sepsis. [ABSTRACT FROM AUTHOR]

Infectious sacroiliitis is an infection of the sacroiliac joint, not easy to diagnose because of its non-specific signs, symptoms and laboratory abnormalities. We describe a case of a 16 year-old male with 5 days’ history of fever, abdominal pain, constipation, low-back and left hip pain extended to the left knee associated with sudden inability to walk. In the first place, magnetic resonance imaging (MRI) examination of his sacroiliac joint revealed an enlarged corpuscolated fluid collection near the left iliopsoas muscle, extended to homolateral paravertebral muscles and a little fluid at the left sacroiliac joint. Drainage by aspiration of the iliopsoas abscess was applied; Staphylococcus aureus was found in the aspirated fluid and isolated from the blood too. Therefore intravenous antibiotic therapy was begun. Follow-up MRI exams confirmed the muscle abscess and revealed also a spongy bone edema of the left sacroiliac joint, persisting despite the disappearance of symptoms and the normalization of inflammatory values. It is important to make an early diagnosis of infectious sacroiliitis in order to begin antibiotic therapy as soon as possible, because of the increasing morbidity of infection of sacroiliac joint. In our case MR findings have provided significant orientation towards the final diagnosis of infectious sacroiliitis.

Introduction: Retroperitoneal necrotizing fasciitis is an uncommon, rapidly fatal condition which often mimics other diseases. Case presentation: We report a case of an elderly woman who was referred to our Emergency Department for suspected acute appendicitis. Computed tomography scan showed an iliopsoas abscess with necrotizing fasciitis on computed tomography scan. Despite aggressive surgical treatment and early antibiotics, she passed away 3 weeks later. Conclusion: Such a case has rarely been reported in an immunocompetent patient who has had no instrumentation, surgeries, or trauma. It serves to highlight the difficulty in diagnosing retroperitoneal necrotizing fasciitis, especially in the elderly patient, as well as the need to recognize it early in the Emergency Department. [ABSTRACT FROM AUTHOR]

Abstract Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) with ST8/SCC mec IV threatens human health. However, its pathogenesis remains unclear. ST8 CA-MRSA (CA-MRSA/J) with SCC mec IVl, which carries the large LPXTG-motif–containing putative adhesin gene, spj, has emerged in Japan. We present the first reported case of death from CA-MRSA/J. The patient was a 64-year-old woman with iliopsoas abscesses complicated by septic pulmonary embolism and multiorgan abscesses. Vancomycin, arbekacin, daptomycin and rifampicin were ineffective. CA-MRSA/J was resistant to erythromycin, clindamycin and antiseptics and was invasive in a HEp-2 cell assay, in contrast to skin-derived villous-adherent CA-MRSA/J. This suggests the strongly invasive pathotype of CA-MRSA/J. [ABSTRACT FROM AUTHOR]