Cases reported "Psoas Abscess"

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1/15. Primary salmonella iliopsoas abscess: a case report.

    Primary iliopsoas abscesses are usually hematogenous or seeded via the lymphatic system from an occult focus. Staphylococcus aureus has been reported to be the predominant pathogen, whereas salmonella sp has rarely been reported to be a major pathogen. We report the case of a 63-year-old woman who presented with a prolonged fever of two weeks' duration. On admission, physical examination revealed tenderness over the left lower abdomen and hip joint, with her thigh in constant flexion. Computerized tomography of the abdomen revealed an iliac fossa abscess. The drained pus culture yielded salmonella group B. Percutaneous catheter drainage and appropriate antimicrobial therapy with ciprofloxacin eventually yielded good results. There was no evidence of other underlying diseases predisposing the patient to the formation of iliopsoas abscess. salmonella infection should be considered in the diagnostic protocols of iliopsoas abscess in taiwan, where salmonellosis is prevalent.
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2/15. Ruptured mycotic aneurysm of the iliac artery complicated by emphysematous psoas muscle abscess: report of two cases.

    Emphysematous psoas muscle abscess has rarely been described and has not been reported to be associated with ruptured mycotic aneurysm. We report two cases of ruptured mycotic iliac arterial aneurysm complicated by emphysematous abscess of the left psoas muscle. Case 1 occurred in a 70-year-old man and Case 2 in a 63-year-old woman. Both patients presented with fever for several weeks. Clinical clues leading to the diagnosis included a palpable abdominal mass with (Case 2) or without (Case 1) pulsation, blurring of the psoas muscle shadow with abnormal gas distribution on the plain abdominal film (Case 1), and peripheral vascular insufficiency and salmonella bacteremia (Case 2). Ruptured mycotic aneurysm of the left iliac artery complicated with left psoas muscle abscess was clearly demonstrated by abdominal computerized tomography scan and intravenous digital subtraction angiography in both cases. Causative agents, multi-drug resistant acinetobacter baumannii and klebsiella pneumoniae, unusual pathogens for mycotic arterial aneurysm, were cultured from debrided tissue in Case 1, and this finding led to the speculation that the infection was hospital-acquired. The favorable outcome in Case 2 resulted from early vascular surgery and a prolonged course of effective antimicrobial therapy.
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3/15. Tuberculous abscesses in patients with AIDS.

    Five cases of large tuberculous abscesses in patients with AIDS were observed over a 2-year period at the new york veterans Affairs Medical Center. These cases represent 11.6% of the 43 cases of tuberculosis diagnosed in patients with AIDS during that period. The abscesses were located in the liver, abdominal wall, psoas muscle, mediastinum, and peripancreatic area. All patients presented with localized pain or swelling, and four of five patients had fever. The diagnosis was made on the basis of detection of abscesses on computed tomography (CT) and the results of culture of abscess material obtained by CT-guided aspiration. CT-guided therapeutic drainage was performed in two cases. Despite administration of therapy, two of five patients died of tuberculous infection. Formation of tuberculous abscesses appears to be a common complication of tuberculosis in patients with AIDS. This diagnosis should be considered for patients with AIDS who have fever and localized pain or swelling.
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4/15. Primary brucellar psoas abscess: presentation of a rare case of psoas abscess caused by brucella melitensis without any osteoarticular involvement.

    The psoas abscess is an entity, sometimes forgotten in our daily practice, because of infrequency and difficulties in diagnosis. Primary psoas abscess is very rare and gram-positive micro-organisms account for more than 80% of the cases. Our case, a 62-year-old man was admitted with a 5-year history of back pain and fever. physical examination was normal, except a palpable hepatomegaly with a mild tenderness over his lower right abdominal quadrant. The Brucella agglutination test was strongly positive with a titre of 1/640, as rose bengal Spot test. blood cultures for brucella were positive on the fourth day and became negative, as the specific therapy started. Further examination with ultrasonography and computed tomography revealed an abscess of 40 75 mm in the psoas muscle. Complete resolution of symptoms achieved within 6 weeks. Although clinical presentation of psoas abscesses is often similar and non-specific, early aetiological diagnosis is extremely important, because of high achievement with appropriate antibiotic regimens. Brucellar psoas abscess seems very rare even in turkey, where Brucella is still highly endemic. Such a case has not been previously reported from turkey, as far as we know.
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5/15. Two cases of pott disease associated with bilateral psoas abscesses: case report.

    STUDY DESIGN: Two case reports and a literature review of spinal osteomyelitis with bilateral psoas abscesses secondary to mycobacterium tuberculosis. OBJECTIVE: Describe the presentation, diagnosis, treatment, and outcome of spinal tuberculosis (i.e., Pott disease). SUMMARY OF BACKGROUND DATA: Pott disease is a well-known condition in unindustrialized countries causing multiple spinal deformities in children. However, its association with bilateral psoas abscesses in adults with minimal risk factors is not commonly recognized in industrialized countries. methods: There are 2 adult cases of Pott disease with psoas abscesses presented, and the relevant literature is reviewed. Plain spine radiographs, spine magnetic resonance imaging (MRI), routine bacterial and acid-fast bacilli cultures of infected material, and other diagnostic testing for M. tuberculosis were performed. RESULTS: Plain radiographs and MRI of the spine showed vertebral osteomyelitis with compression fractures, and MRI also revealed bilateral psoas abscesses. Acid-fast bacilli culture and other M. tuberculosis diagnostic testing of psoas abscess specimens confirmed the diagnosis of M. tuberculosis. CONCLUSION: Although spinal osteomyelitis with psoas abscess is classically associated with Staphylococcus aureus infection, Pott disease should be considered in this clinical setting, and risk factor assessment and testing for tuberculosis should be performed.
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6/15. Pelvic abscess induced by a methicillin-resistant staphylococcus aureus from haematogenous spread via the CVP line in a burn patient.

    A 38-year-old female patients was found accidentally to have a positive culture of MRSA from a routine CVP catheter tip culture 1 week after she had complete wound closure. She was recovering from a partial skin thickness burn covering 42 per cent TBSA on the trunk and extremities. fever and hip pain developed abruptly 1 week later when she was ready for discharge from hospital. magnetic resonance imaging (MRI) of the pelvis disclosed an intramuscular abscess. Open drainage was performed and pus culture yielded a MRSA with the same sensitivity profile as the previous CVP tip culture. vancomycin 500 mg every 6 h was used for 3 weeks until the drain culture disclosed a negative result, and a follow-up MRI indicated a loss of the abscess space. Follow-up at an outpatient clinic 3 months later showed that the patient remained symptom free. In this patient haematogenous dissemination was the most likely route of pelvic abscess formation. It should be remembered that MRSA infection is not always only a local problem, especially in the immunocompromised condition of burn injury.
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7/15. Successful medical treatment for staphylococcal vertebral osteomyelitis complicated by spinal epidural abscess, psoas abscess and meningitis: a case report.

    A 42 year-old farmer was transferred to our hospital for recently exaggerated lower back pain. Neurological examination revealed an L4 radiculopathy on the right side. meningitis developed after admission. MRI showed L4-5 osteomyelitis and discitis with contiguous spinal epidural abscess and right psoas abscess. blood culture and CSF culture both grew Staphylococcus aureus. Because the patient refused to receive a drainage procedure, we gave him antibiotics which resulted in a favorable outcome.
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8/15. Non-spinal psoas abscess due to mycobacterium tuberculosis in a patient with acquired immunodeficiency syndrome: report of a case.

    Of the 36 patients with human immunodeficiency virus (hiv) infection admitted to our institution since 1985, one had a non-spinal psoas abscess due to mycobacterium tuberculosis without pulmonary involvement. A 32-year-old male homosexual had prolonged fever and weight loss for two months. serologic tests for antibodies against hiv were positive. A characteristic hypodense lesion within the right psoas muscle was noted by computerized tomographic (CT) scanning. diagnosis of psoas abscess was confirmed by ultrasound-guided needle aspiration. The smear of the aspirated pus showed numerous acid-fast bacilli and cultures grew M. tuberculosis. The lesion responded rapidly to antituberculous therapy and a follow-up CT scan 10 months later showed improvement.
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9/15. Molecular confirmation of bacillus Calmette-Guerin as the cause of pulmonary infection following urinary tract instillation.

    Instillation into the urinary tract of the bacillus Calmette-Guerin (BCG), a strain of mycobacterium bovis, is associated only rarely with severe side effects. We report here two cases of culture-proven pulmonary infection due to therapy with BCG. The first patient, who was seropositive for the human immunodeficiency virus, developed bilateral interstitial pneumonitis after instillation of BCG into the bladder. The second patient developed a right-lower-lobe infiltrate and empyema after instillation of BCG into the right renal pelvis. The clinical isolates from these two patients and from a third patient with a psoas abscess following intravesical instillation were analyzed with use of pulsed field gel electrophoresis (PFGE) to resolve chromosomal restriction fragment polymorphisms. The clinical isolates were confirmed to be BCG by comparison with known vaccine strains that differed from M. bovis isolates. We conclude that the potential for subsequent dissemination be considered prior to the intravesical administration of BCG. Analysis with PFGE may be useful for identifying species of the mycobacterium tuberculosis complex.
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10/15. Neonatal psoas pyomyositis simulating pyarthrosis of the hip.

    osteomyelitis with concomitant pyarthrosis or isolated pyarthrosis heads the differential list for a newborn with limb disuse and a flexion deformity of the hip. The diagnosis of psoas abscess, a primary suppurative myositis, should additionally be entertained. Stronger consideration should be given to this clinical entity after pyarthrosis of the hip has been excluded by an arthrocentesis performed under fluoroscopy. Radiologic imaging may facilitate the diagnosis. A blood culture may yield the organism responsible for the skeletal muscle abscess, even in nontoxic patients.
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