George James C, Sainulabdeen Jishar, Chittaranjan Samuel, Babu Subin
Department of Orthopaedics, Believers Church Medical College and Hospital, Thiruvalla, Kerala, India.
J Orthop Case Rep. 2021 Oct;11(10):45-48. doi: 10.13107/jocr.2021.v11.i10.2462.
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.
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 .
Our patient had primary bilateral iliopsoas abscess with bilateral hip Streptococcus faeeacalis septic arthritis. It has not been reported in the literature till now .
Early diagnosis through meticulous clinical examination and investigations is important in treatment of the abscess and reducing morbidity and mortality.
髂腰肌脓肿是一种罕见疾病，症状往往隐匿且不具特异性。患者常表现为跛行、发热、体重减轻以及侧腹或腹痛。根据是否存在基础疾病，髂腰肌脓肿可分为原发性或继发性。原发性脓肿在亚洲和其他发展中国家非常常见。若不治疗，髂腰肌脓肿可蔓延至下肢，压迫髂静脉、输尿管，最终导致败血症。迄今为止，仅有极少数伴有髋关节化脓性关节炎的腰大肌脓肿病例报道。双侧髂腰肌脓肿也是一种罕见病症。
我们在此报告一名58岁的糖尿病女性患者，一个月前在家中摔倒后出现发热和双侧髋部疼痛。她最初在其他地方就诊，诊断为L4-L5椎间盘膨出，随后接受了休息、止痛和类固醇治疗。后来，重复磁共振成像（MRI）显示双侧髂肌脓肿和双侧髋关节滑膜炎。她开始接受抗结核药物治疗，并转诊至我们这里。我们对隐匿性感染源进行了检查，并进行了双侧髂腰肌脓肿引流，随后分期进行双侧全髋关节置换。她现在仍无症状。
我们的患者患有原发性双侧髂腰肌脓肿伴双侧髋关节粪肠球菌化脓性关节炎。此前文献中尚无此病例报道。
通过细致的临床检查和调查进行早期诊断，对于脓肿的治疗以及降低发病率和死亡率至关重要。
