Abstract

A 21-year-old, recent Indian migrant to Australia, presented to the Emergency Department with a 3-week history of worsening right buttock and thigh pain and weakness, associated with fever of up to 39°C and weight loss of 3 kg. On examination, the patient demonstrated a right-sided antalgic gait with a limp and weakness of right hip flexion. The patient was tachycardic with a heart rate of 140, and had  raised inflammatory markers with white blood cell count of 13.0 × 109/ L and C-reactive protein of 246 mg/L. Subsequent MRI pelvis revealed a 69 mm × 25 mm × 38 mm, right-sided iliopsoas abscess with oedema extending to the right paraspinal muscle at the level of 5th lumbar vertebra, associated with the enhancement of 5th right hemi-lumbar vertebra, the right side of the sacrum and adjacent ilium consistent with osteomyelitis of these bones. CT-guided percutaneous drainage of the iliopsoas abscess was performed, and 30 ml of haemopurulent fluid was aspirated and sent for microbial culture. Abscess cultured methicillin-sensitive Staphylococcus aureus. The patient was treated with 2 weeks of intravenous flucloxacillin, and further 3 weeks of oral flucloxacillin. At follow-up in 3 months, the patient was pain free and inflammatory markers had normalised.

Key words: Abscess, iliopsoas, osteomyelitis, drainage, CT-guided, osteomyelitis, vertebral, osteomyelitis, sacroiliac

Abbreviation

IPA, Iliopsoas abscess; CT, Computer tomography; MRI, Magnetic resonance imaging.