Amano Shiho, Ohta Ryuichi, Sano Chiaki
Community Care, Unnan City Hospital, Unnan, JPN.
Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN.
Cureus. 2022 Jul 14;14(7):e26854. doi: 10.7759/cureus.26854. eCollection 2022 Jul.
A psoas abscess, a collection of pus in the psoas muscle, is rare but the incidence is increasing with the use of computed tomography (CT) and magnetic resonance imaging (MRI). Pyomyositis, a muscular infection that does not lead to abscess formation, is well known as tropical pyomyositis because it is highly prevalent in tropical areas. We encountered a case of iliopsoas pyomyositis and bacteremia without abscess formation. The blood culture was positive despite the early stage of presentation and no abscess formation on MRI. Imaging is the gold standard for diagnosing iliopsoas abscesses. There are cases similar to ours wherein the blood culture is positive before the formation of an abscess. Regardless of whether an abscess is found on MRI or not, we need to consider the possibility of false negatives at the early stage of presentation. A suspicion of this disease is essential during a physical examination for early diagnosis and treatment, especially in rural areas, where medical resources are limited. Furthermore, pyomyositis is a common disease in tropical regions, but in recent years, case reports of occurrences in temperate regions have increased. This case indicates the need to consider pyomyositis as a differential diagnosis of fever and hip joint pain even in temperate regions.
腰大肌脓肿是指腰大肌内的脓液积聚，较为罕见，但随着计算机断层扫描（CT）和磁共振成像（MRI）的应用，其发病率正在上升。脓性肌炎是一种不会导致脓肿形成的肌肉感染，因在热带地区高发而被称为热带脓性肌炎。我们遇到一例髂腰肌脓性肌炎且伴有菌血症但未形成脓肿的病例。尽管就诊时处于早期且MRI未显示脓肿形成，但血培养呈阳性。影像学检查是诊断腰大肌脓肿的金标准。有一些与我们的病例类似的情况，即在脓肿形成之前血培养就呈阳性。无论MRI上是否发现脓肿，在就诊早期我们都需要考虑假阴性的可能性。在体格检查时怀疑此病对于早期诊断和治疗至关重要，尤其是在医疗资源有限的农村地区。此外，脓性肌炎在热带地区是一种常见疾病，但近年来，温带地区的病例报告有所增加。该病例表明，即使在温带地区，也需要将脓性肌炎作为发热和髋关节疼痛的鉴别诊断考虑在内。
