Primary psoas abscess. Report of three cases.
BACKGROUND
Primary psoas abscesses are a rare clinical entity with subtle and non specific symptoms, most commonly seen in patients predisposed to infections. Early diagnosis and appropriate management are therefore challenging aspects for physicians.


METHODS
We present three patients with primary pyogenic psoas abscess, treated at the Heraklion University Hospital, during a 5-year period. The two male and one female patient, aged 36-51 years were admitted with fever, abdominal pain and a palpable tender mass.


RESULTS
The classical sign of limping was absent in all cases. Positive psoas symptoms were detected in only two patients. CT scan accurately confirmed the diagnosis in all cases. The patients were successfully treated with antibiotics and prolonged surgical drainage. Staphylococcus aureus was the causative microorganism in the first two and Bacteroides fragilis in the third patient. This is the first reported case resulting from this specific bacteria. None of our patients had any predisposing risk factor.


CONCLUSIONS
A high index of suspicion is mandatory to enable early recognition of this rare clinical disease. CT scan is the standard diagnostic tool to confirm diagnosis. Prolonged drainage and appropriate antibiotics are essential for the successful treatment of primary psoas abscesses.
Melissas
J
J
Department of Surgical Oncology, Heraklion, University Hospital, Greece. melissas@med.uoc.gr
Romanos
J
J
de Bree
E
E
Schoretsanitis
G
G
Askoxylakis
J
J
Tsiftsis
D D
DD
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001442:Bacteroides Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016659:Psoas Abscess / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D013203:Staphylococcal Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin