Abstract

Psoas abscess is a relatively rare condition with varying clinical presentation. Therefore, the diagnosis and treatment are frequently delayed. Psoas abscess can extend into the spine and cause spinal infection or spinal infection can be a source for secondary psoas abscess. It has 100% mortality if left untreated. Broad-spectrum antibiotics and drainage of pus by either percutaneous drain insertion or open surgery are the treatment modalities.  A 62-year-old patient, male patient with long-standing diabetes and ischemic heart disease presented with fever and lower back pain for four days duration without any systemic focus of infection. He was hemodynamically stable, and neurological examinations of the lower limb were normal on admission. He developed bilateral lower limb weakness on the 7th day of hospital stay, and neurological examinations of the lower limb revealed flaccid paralysis. His Contrast Enhanced Computerized Tomography (CECT) of the abdomen revealed a bilateral psoas abscess. Both pus culture and blood culture were positive for Methicillin-resistant staphylococcus aureus. Later, his Magnetic Resonance Image (MRI) spine revealed infective multilevel spondylodiscitis, arachnoiditis, radiculitis, and early infective myelitis. The abscess was drained, and a broad-spectrum antibiotic was started. Unfortunately, he passed away despite maximal medication intervention due to septicemia, acute kidney injury, and septic shock. Even though rare, psoas abscess should be suspected in a patient with back pain, fever, and high inflammatory markers due to its high mortality and morbidity. Early diagnosis and treatment can reduce mortality and morbidity. However, advanced age, presence of bacteremia, and poorly controlled diabetes carry poor prognosis.