Bilateral Psoas Abscess with Extension to Flanks through Iliac Bone Erosion.

Spinal tuberculosis is common in endemic regions. Psoas abscess associated with lumbosacral tuberculosis is a common finding in long standing cases. But vague symptoms and signs make the clinical diagnosis of psoas abscess with tuberculous spondylodiscitis a challenge. A 22-year-old married female presented with low backache, anorexia and bilateral swellings in the flank regions. The swellings extended to the upper medial quadrant of the buttocks bilaterally. Abdominal ultrasonography showed bilateral psoas abscesses above inguinal ligaments and extending into buttocks bilaterally after iliac bone erosion. Magnetic resonance images showed diffuse spondylodiscitis from L1 to S1 and bilateral psoas abscesses, erosion of the iliac bones and a large subfascial abscess over the gluteal muscles. The communication of the buttock abscess into the retroperitoneum and and with the psoas abscess was evident. Operative drainage of abscesses was performed and histological examination showed caseaous necrosis confirming the clinical diagnosis of tuberculosis. Antituberculous therapy was started and continued for 12 months with complete recovery. [ABSTRACT FROM AUTHOR]