Primary tuberculous psoas abscess as a postpartum complication: Case report and literature review

Abstract

Background:Primary psoas abscess is an unusual clinical entity rarely encountered in the postpartum period. Only seven cases have been reported to date. Here, we present a woman with a primary psoas abscess caused by Mycobacterium tuberculosis and occurred 2 months following a normal vaginal birth. We highlight the difficulties in the management of this uncommon condition in light of the relevant literature.Case Description:A 34-year-old woman who was previously healthy was presented at 2 months’ postpartum with important right sciatica and low back pain without fever. Examination of the abdomen revealed tenderness in the right iliac fossa but obstetric/gynecologic and neurologic examinations were normal. The patient had an elevated C-reactive protein level and computed tomography (CT)-scan demonstrated a large psoas abscess on the right side without sacroiliac or spine abnormalities. Initial posterior lumbar percutaneous drainage was useful, but no pathogens were identified. The patient was discharged home with oral antibiotics therapy (amoxicillin/clavulanate and metronidazole). Four weeks later, the follow-up CT-scan showed a re-accumulation of the abscess cavity. Subsequently, the patient underwent a right anterolateral laparotomy with a retroperitoneal approach for abscess drainage. Again, no microorganisms were found. However, diagnosis of tuberculosis was established on histopathologic study. She was successfully treated with antituberculous drugs with a good outcome.Conclusions:Most primary psoas abscesses present with a delay in diagnosis because of the rarity of this infectious disease, the lack of specific symptoms and signs, and its similarity to many differential diagnoses. When suspected, CT-scan and/or magnetic resonance imaging help in making an accurate diagnosis and facilitate percutaneous or open surgical drainage of the abscess. Correct and fast identification of the microorganisms in addition to appropriate usage of antibiotic regimen improves the outcome.

Isolated psoas abscess caused by Mycobacterium tuberculosis: A rare case report

“…11,[17][18][19][20][21][22][23][24] One of which was reported as a postpartum complication in which patient was an afebrile young woman with low back pain which was drained and four weeks after the cavity was reaccumulated and on the second drainage, TB was diagnosed and appropriate antibiotic therapy was commenced. 17 Another case was reported with nonspecific presentation; however, patient's husband was diagnosed with pulmonary TB 3 years prior. The diagnosis was established after many tests with a 4 weeks delay (due to the rarity of this condition) through a positive Lõwenstein culture.…”

“…TB psoas abscess as the only manifestation of TB in a patient without any previous predisposing pathology is exceptional. To our knowledge, (Pubmed up to 2021 Abscess, Psoas, Tuberculosis), 9 cases have been reported previously 11,17–24 …”

“…To our knowledge, (Pubmed up to 2021 Abscess, Psoas, Tuberculosis), 9 cases have been reported previously. 11,[17][18][19][20][21][22][23][24] One of which was reported as a postpartum complication in which patient was an afebrile young woman with low back pain which was drained and four weeks after the cavity was reaccumulated and on the second drainage, TB was diagnosed and appropriate antibiotic therapy was commenced. 17 Another case was reported with nonspecific presentation; however, patient's husband was diagnosed with pulmonary TB 3 years prior.…”

A case report of perinephric abscess extending as psoas abscess

“…Computed tomography is done for definitive diagnosis but some authors believe MRI may be superior because of better discrimination of soft tissue. 4,5 Treatment usually involves usage of appropriate antibiotics and prompt drainage. 4…”

Pelvic and central nervous system tuberculosis complicated by a paradoxical response manifesting as a spinal tuberculoma: a case report

“…In addition, immune reconstitution in the post-partum period has been associated with unmasking or worsening symptoms of TB [9,10]. While reports of TB presenting in the postpartum period are well documented [9][10][11][12][13][14][15], few have described TB presenting after abortion [16][17][18][19].…”