Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study

Abstract

BackgroundIliopsoas abscess (IPA) is a rare clinical entity and is difficult to diagnose due to its insidious onset and nonspecific symptoms. The association between IPA and cardiovascular disorders (CVD) has been rarely reported. Computed tomographic (CT) scan can provide a definitive diagnosis of IPA and associated foci of adjacent structures. IPA is a life-threatening condition, especially when associated with CVD.Materials and methodsWe conducted a hospital-based observational study of IPA associated with CVD. Data were collected from the electronic clinical database of Taichung Veterans General Hospital (1520-bed tertiary referral hospital in central Taiwan) between July 2007 and December 2017. The diagnosis of IPA associated with CVD was confirmed by classical findings on CT and transesophageal echocardiography with compatible clinical presentation and cultures from pus/tissue and blood.ResultsFifteen patients of IPA associated with CVD were studied. They included 12 males (80%) and 3 females (20%), with a mean age 63.2 ± 16.9 years (31–85 years). CVD included stent-graft/endograft infection of abdominal aortic aneurysm (AAA) (40%), primary mycotic AAA (33.3%), and infective endocarditis (26.7%). Staphylococcus aureus is the most common microorganism in pus/tissue cultures (n = 3, 37.5%) and in blood cultures (n = 6, 40%). The average length of hospital stay was 33.1 ± 20.5 days (range, 3–81 days; median, 33 days). Hospital stay lasted 42.6 ± 19.2 days in the survival group and 19.0 ± 14.1 days (P = 0.018) in the non-survival group. Incidence of patients staying in the intensive care unit (ICU) with intubation > 3 days was 33% in the survival group and 100% (P = 0.028) in the non-survival group. Intra-hospital mortality rate was 40%. Poor prognostic factors in the non-survival group were hypoalbuminemia, hyponatremia, involved disc/vertebral body and/or epidural abscess, and ICU stay with intubation > 3 days. Cumulative survival rate was 25% under conservative treatments and 66.3% under aggressive treatments (P = 0.038).ConclusionDue to high mortality rates, clinicians should keep a high suspicion index for IPA associated with CVD through clinical presentation, physical examination, and imaging study. Timely empiric antibiotics for common bacteria, drainage for IPA, endovascular repair, or vascular reconstruction by graft replacement or bypass with intensive care should be mandatory to shorten the hospital stay, reduce medical costs, and lower mortality rate.

Detection of mecA and 16S rRNA Genes Using Real-Time PCR Can Be Useful in Diagnosing Iliopsoas Abscess, Especially in Culture-Negative Cases: RT-PCR for Iliopsoas Abscess

“…Iliopsoas abscess is a relatively rare disorder that has a diversity of frequency depending on patients' race, gender, and preexisting diseases [1]. Sequential iliopsoas abscess has been reported in the immunological suppression in rheumatoid arthritis, cervical spondylosis infection, ulcerative colitis, malignant tumor cases, and cardiovascular disorders [22][23][24][25][26]. Our study demonstrated that undernutrition is an indicator for the possible presence of IPA; however, serum inflammatory markers may not be useful to differentiate IPA from other inflammatory responses.…”

A Microbiologist’s Mexico Trip Ends with Multiple Tiny Ring-Like Pelvic Abscesses

“…According to some studies, MRI is superior to CT because of better delineation of soft tissues and the visualization of abscess walls [12]. Broad-spectrum antibiotics and percutaneous drainage are the treatment of choice in iliopsoas abscess and should be started even before the culture results come back [13,14]. In our case, because of the collection of multiple small abscesses, percutaneous drainage was not an option.…”

Imaging features of mycotic aortic aneurysms

“…In tuberculous spondylitis patients, MAAs can involve secondary spread from spine lesions (Figure 7). The rate of mortality is high among MAA patients with combined pyogenic spondylitis (34,35).…”