Intensive Care Unit, Guangdong Provincial People's Hospital, Zhuhai Hospital (Jinwan Central Hospital of Zhuhai), Zhuhai, China.
Department of Nephrology, Guangdong Provincial People's Hospital, Zhuhai Hospital (Jinwan Central Hospital of Zhuhai), Zhuhai, China.
Medicine (Baltimore). 2024 Aug 16;103(33):e39356. doi: 10.1097/MD.0000000000039356.
Iliopsoas abscess is a rare acute medical condition. It usually occurs because of the spread of infection from adjacent structures and hematogenous spread. Clinical features include fever, backache, radiating nerve root pain, and leg weakness. When sepsis occurs, prompt recognition is required to initiate appropriate antimicrobial therapy and surgical drainage.
A 65-year-old male presented to the outpatient department with a 2-day history of lower back, hip, and leg pain, for which analgesics were administered. During hospitalization, he experienced deterioration, becoming febrile, hypoxic, hypotensive, tachycardiac, and delirious.
The patient was then intubated and ventilated. His family reported an additional history of acupuncture for back pain, which sustained an inflamed wound on his right forearm. Abdominal computed tomography was performed, which confirmed bilateral iliopsoas abscess without involvement of intra-abdominal organs. A preliminary report of blood culture revealed Gram-positive cocci. Echocardiography showed vegetation on the aortic valve, and moderate aortic regurgitation was sustained. He was started on vancomycin along with piperacillin-tazobactam. Ultrasound-guided percutaneous drainage was inserted into the bilateral abscess. Pus and blood yielded methicillin-sensitive Staphylococcus aureus. He remained septic. The repeat computed tomography showed the right abscess enlarged. A repeated echocardiogram showed that the vegetation increased. Further incision and surgical drainage were performed with continuous wash-out.
His condition improved after management and he was discharged to a regional hospital for ongoing care.
Prompt diagnosis and surgical treatment are essential to improve patient outcomes. The unique aspect of this case is the persistence of the methicillin-sensitive Staphylococcus aureus infection. Centralized surgical services are pivotal in conjunction with robust antimicrobial regimens.
This case reinforces the importance of high clinical suspicion of an unknown source of sepsis.
髂腰肌脓肿是一种罕见的急性疾病。它通常是由于感染从邻近结构扩散和血行播散引起的。临床特征包括发热、背痛、神经根放射痛和下肢无力。当发生败血症时，需要迅速识别，以启动适当的抗菌治疗和手术引流。
一名 65 岁男性因 2 天的下背部、臀部和腿部疼痛到门诊就诊，给予了止痛药。住院期间，他病情恶化，出现发热、缺氧、低血压、心动过速和神志不清。
随后对患者进行了气管插管和通气。他的家人报告说，他还有一次背部疼痛的针灸治疗史，导致其右前臂的伤口发炎。进行了腹部计算机断层扫描，证实双侧髂腰肌脓肿，未累及腹腔器官。血培养的初步报告显示为革兰阳性球菌。超声心动图显示主动脉瓣有赘生物，且持续中度主动脉瓣反流。他开始使用万古霉素和哌拉西林他唑巴坦。超声引导下经皮引流术插入双侧脓肿。脓液和血液培养出对甲氧西林敏感的金黄色葡萄球菌。他仍处于败血症状态。重复计算机断层扫描显示右侧脓肿增大。重复超声心动图显示赘生物增加。进一步进行了切开和外科引流，并持续冲洗。
经过治疗，他的病情有所改善，并出院到区域医院进行后续治疗。
及时诊断和手术治疗对于改善患者预后至关重要。本例的独特之处在于对甲氧西林敏感的金黄色葡萄球菌感染的持续存在。集中的外科服务与强有力的抗菌方案相结合至关重要。
本病例强调了对不明来源败血症的高度临床怀疑的重要性。
