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PubMed2004

Disseminated pyogenic Mycoplasma pneumoniae infection in a renal transplant recipient, detected by broad-range polymerase chain reaction.

Although extrapulmonary manifestations of Mycoplasma pneumoniae infection are generally immune-mediated, disseminated infections occasionally occur. We describe a renal transplant recipient who developed disseminated pyogenic M. pneumoniae infection that was detected by broad-range polymerase chain reaction and that manifested by prosthetic arterial graft infection, psoas abscess, and septic arthritis.

Adult↗
PubMed1996

Liquefactive panniculitis in the inguinal area as the first sign of chronic renal brucellosis.

We describe an 82-year-old woman with an acute panniculitis in the left groin as the first sign of chronic renal brucellosis. She was afebrile and had a large erythematoviolaceous plaque with ulceration and liquefaction of the subcutaneous tissue. Histopathologic study showed a septal and lobular panniculitis with neutrophil infiltration, hemorrhage, and necrosis. Microbiologic cultures of a skin biopsy specimen, blood, and urine were negative. A computed tomography scan showed a left "mastic" kidney with a psoas abscess extending to the left inguinal region. The microbiologic culture of the removed renal mass and the serologic tests established the diagnosis of chronic renal brucellosis. Although the clinical picture of cold abscesses in the inguinal area classically suggests a tuberculosis, brucellosis should be included in the differential diagnosis.

Aged↗
PubMed1998

Unusual infections in diabetes.

Infection with rare organisms or at unusual sites occur more frequently in people with diabetes. If not recognised and treated promptly, morbidity and mortality are high in such cases. Here we report cases of necrotising fascitis, malignant otitis externa, Fournier's gangrene and psoas abscess occurring in diabetics that needed intensive treatment with antibiotics, surgical debridement and insulin. Literature reviews suggest that cellular defence mechanisms may be impaired in people with diabetes.

Adult↗
PubMed1995

[Extrapulmonary tuberculosis in 3 Dutch patients].

In three patients, two women aged 71 and 59 years and a man aged 49 who had been living in the Netherlands for a long time and who were admitted because of vague symptoms, extrapulmonary manifestations of tuberculosis were diagnosed: tuberculosis of the lumbar spine with psoas abscess, tuberculous peritonitis and adrenal tuberculosis with Addison's disease in a patient with open pulmonary tuberculosis. All three recovered with tuberculostatic therapy (isoniazid, streptomycin, pyrazinamide and rifampicin).

Addison Disease↗
PubMed1997

Propionibacterium avidum sacroiliitis and osteomyelitis.

The anaerobic Gram-positive bacterium Propionibacterium avidum is a common inhabitant of the skin with low pathogenicity. We report a case of P. avidum sacroilitis, psoas abscess and osteomyelitis in a 67-year-old male who had recently undergone surgical repair of an inguinal hernia. The organism was recovered from blood cultures, a bone biopsy specimen and specimens from the abscess. The spectrum of bone and joint infections caused by Propionibacterium is discussed. Infection by Propionibacterium spp. should be considered in patients with bone and joint infections.

Aged↗
PubMed1999

[Spinal tuberculosis in children: contribution of imaging to diagnostic and therapeutic management].

BACKGROUND: Spinal tuberculosis is an increasingly common condition, particularly in children. CASE REPORT: A 2-year-old boy presented with spinal tuberculosis with psoas abscesses. Radiological imaging played a major role in the diagnostic process. DISCUSSION: In children, spinal tuberculosis is a serious condition due to its rapid spread. Clinical symptoms are often insidious and histological and bacteriological studies may fail to disclose the diagnosis. Radiological investigations are essential in the diagnostic approach.

Child↗
PubMed2006

Ceftriaxone-resistant Salmonella septicemia and osteomyelitis in sickle cell disease adults.

The majority of data evaluating Salmonella infections in sickle cell anemia (SCD) comes from studies performed in children. We report a SCD adult who presented with ceftriaxone-resistant Salmonella bacteremia. After appropriate initial therapy, persistent back pain prompted evaluation by magnetic resonance imaging of the spine, which revealed osteomyelitis and a psoas abscess. The patient responded to percutaneous drainage and antibiotics. This report summarizes some of the findings of large SCD studies evaluating Salmonella bacteremia and osteomyelitis, focusing on adults. Our case exemplifies the need for antibiotic coverage for Salmonella species in adult SCD patients with septicemia. We argue that imaging studies looking for osteomyelitis should be done routinely in SCD patients with Salmonella bacteremia.

Adult↗
PubMed2005

Recurrent infections caused by cefotaxime- and ciprofloxacin-resistant Salmonella enterica serotype choleraesuis treated successfully with imipenem.

We present a case of recurrent infection (infective spondilitis, psoas abscess, and bacteraemia) caused by a single strain of cefotaxime- and ciprofloxacin-resistant and bla(CMY-2)-containing Salmonella enterica serotype choleraesuis during a 4-month period in a patient with uremia. The patient was successfully treated with imipenem for 7 weeks. Our observation indicates that a carbapenem might be considered as a drug of choice for the treatment of infections caused by this emerging multi-resistant pathogen.

Anti-Bacterial Agents↗
PubMed1992

Primary pyogenic abscess of the psoas muscle.

Nine children who were less than nine years old and had a primary pyogenic abscess of the psoas muscle were treated in a five-year period. This rare lesion often simulated septic arthritis of the hip. Ultrasonography was found to be the most reliable and easily performed diagnostic study. Because of the rarity of the lesion, the diagnosis requires a high index of suspicion. The best treatment is early operative drainage and administration of systemic antibiotics.

Child↗
PubMed1993

Molecular confirmation of bacillus Calmette-Guérin as the cause of pulmonary infection following urinary tract instillation.

Instillation into the urinary tract of the bacillus Calmette-Guérin (BCG), a strain of Mycobacterium bovis, is associated only rarely with severe side effects. We report here two cases of culture-proven pulmonary infection due to therapy with BCG. The first patient, who was seropositive for the human immunodeficiency virus, developed bilateral interstitial pneumonitis after instillation of BCG into the bladder. The second patient developed a right-lower-lobe infiltrate and empyema after instillation of BCG into the right renal pelvis. The clinical isolates from these two patients and from a third patient with a psoas abscess following intravesical instillation were analyzed with use of pulsed field gel electrophoresis (PFGE) to resolve chromosomal restriction fragment polymorphisms. The clinical isolates were confirmed to be BCG by comparison with known vaccine strains that differed from M. bovis isolates. We conclude that the potential for subsequent dissemination be considered prior to the intravesical administration of BCG. Analysis with PFGE may be useful for identifying species of the Mycobacterium tuberculosis complex.

Administration, Intravesical↗
PubMed1995

Iliopsoas compartment: normal anatomy and pathologic processes.

The iliopsoas compartment is an extraperitoneal space that contains the greater psoas, smaller psoas, and iliac muscles. Many pathologic processes may involve the iliopsoas compartment, including inflammatory, hemorrhagic, and neoplastic conditions. Psoas muscle infection is usually due to direct extension from contiguous structures. With the decreasing incidence of tuberculosis, the majority of psoas abscesses now encountered have a pyogenic origin. Hemorrhage into the psoas muscle can be spontaneous or secondary to various conditions. Neoplastic involvement of the psoas muscle is usually due to contiguous spread and is rarely primary. With the refinement of imaging modalities, there has been increased recognition of diseases that involve the iliopsoas compartment. Although these conditions may look similar radiologically, they can be correctly diagnosed by combining the radiologic findings with the clinical history. Biopsy is effective in diagnosis of such conditions; aspiration and drainage are effective in both diagnosis and therapy.

Abscess↗
PubMed1988

[Pyogenic sacroiliitis. Review of 8 personal cases and 200 cases from the literature].

Eight patients with a pyogenic infection of the sacroiliac joint are compared to 200 published cases. In all our patients the disease began with fever and immobilizing low back and buttock pain. All had bacterial growth in the blood cultures. Five out of 6 patients did not show inflammatory signs in the initial plain roentgenogram. Tc-99m scan was initially positive in 4 out of 6 patients. In 2 patients only the second scan, at 13 and 15 days respectively, was positive. All but one patient had a 4-6 week course of intravenous antibiotics. Three patients underwent surgery for abscesses or intraarticular sequestra. One patient with a small psoas abscess had only medical treatment under CT monitoring. All the patients recovered. From our observations and the literature we conclude that pyogenic sacroiliitis is often not recognized initially. Wrong diagnoses such as sepsis of unknown origin, appendicitis, discal hernia etc. can be avoided if pyogenic sacroiliitis is sought in a systematic fashion. The clinical diagnosis can be confirmed by bone scan, to be repeated at a later stage of disease (i.e. two weeks after onset) if the first examination is inconclusive.

Adolescent↗
PubMed1998

Primary pyogenic abscess of the psoas muscle.

During a six-year period, eleven persons with primary pyogenic abscess of the psoas muscle were treated at the Mackay Memorial Hospital. Five were males and six were females and their average age was 47.2 years (range 6-83 years). The abscess was identified by CT in 7 patients, MRI in 2 and ultrasonography in 1. One abscess was found during laparotomy. Treatment included extraperitoneal drainage of the abscess in 7 patients and CT guided aspiration in 3. One patient improved after antibiotic therapy and they all recovered after treatment. The diagnosis of primary pyogenic abscess requires a high index of suspicion and the best treatment is early operative drainage and administration of systemic antibiotics.

Adolescent↗
PubMed2005

[Abscess of the psoas muscle caused by a psoas compartment catheter. Case report of a rare complication of peripheral catheter regional anaesthesia].

A 27-year-old female patient was continuously treated with a psoas compartment catheter for pain therapy. The catheter was placed under strictly aseptic conditions. After 5 days a painful swelling and erythema were observed at the catheter introduction site and the catheter was removed. At the tip of the catheter a staphylococcus aureus infection was detected. A few days after removing the catheter, the patient showed signs of a general infection such as fever and an increase of CRP. An abscess of the psoas muscle was diagnosed via computer tomography. After treatment with antibiotics the abscess was healed and the patient was discharged after 21 days. An abscess of the psoas muscle is a rare complication of psoas compartment catheters. Erythema, pain or swelling at the site of introduction can be a sign of infection and the catheter must be removed immediately. In addition to the case report a review of the literature is given with data on risk management and own infection rates by 2304 peripheral pain catheters.

Adult↗
PubMed1991

Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients.

Septic metastatic endophthalmitis from Klebsiella pneumoniae liver abscess, first reported in seven cases treated at the Veterans General Hospital, Taipei, Taiwan, between 1981 and 1985, was seen in six similar cases at the same hospital in the subsequent 2 years. We conducted a retrospective search for factors that might be associated with these complications of pyogenic liver abscess. A total of 23 cases with septic metastatic lesions from pyogenic liver abscess were found between 1981 and 1987, and 164 cases of pyogenic liver abscess without septic metastatic lesions were identified as a comparison group. Klebsiella pneumoniae liver abscess, bacteremia, and the underlying diabetes mellitus were significantly more common in the study group than in the comparison group. Of the 23 patients with septic metastatic lesions, there were 14 cases (60.8%) of endophthalmitis or uveitis, 10 cases (43.4%) of pulmonary abscess and/or emboli, six cases (26.0%) of brain abscess and/or purulent meningitis, five cases (21.7%) of bacteriuria and/or prostate abscess, two cases (8.6%) of osteomyelitis and/or pyogenic arthritis, and one case (4.3%) of psoas abscess.

Adult↗
PubMed1994

[Primary abscess of the psoas. A common disease in tropical countries. Apropos of 87 cases].

Over a 4 years period, 87 cases of primary abscesses of the psoas were treated surgically at the Central Hospital in Yaoundé. The psoas muscle was involved in 10.17% of the cases with myositis. Most patients were in young male and the abscesses were in an advanced stage. Staphylococcus was the most frequently encountered germ (78.4%) and enterobacteria were only found in 3.07%. The diagnosis was based on clinical and echographic findings. There was 1 patient with acquired immunodeficiency syndrome (AIDS). Most cases were treated by extraperitoneal drainage. Morbidity and mortality were low and generally occurred in debilitated patients (AIDS, involvement of several muscle groups, diabetes).

AIDS-Related Opportunistic Infections↗