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El absceso del psoas es una enfermedad infecciosa infrecuente y de difícil diagnóstico, caracterizado por una colección purulenta a nivel de este músculo, que provoca un síndrome de respuesta inflamatoria sistémica. La infección puede ser primaria por diseminación hematógena, o secundaria, a partir de un foco infeccioso cercano. Su presentación durante el embarazo es rara, y predomina la forma primaria, razón por la cual se decidió realizar este artículo. Se presenta el caso de una gestante con 28,4 semanas de edad gestacional que ingresó por dolor inguinal con posterior irradiación a la cadera, flanco y región lumbar derechos; postura en flexión de la cadera derecha y marcha antiálgica, así como aparición, a los nueve días de iniciados los síntomas, de una masa dolorosa entre fosa ilíaca y flanco derechos. Los hallazgos de la ecografía abdominal y la resonancia permitieron el diagnóstico de un plastrón apendicular con un apéndice retrocecal, así como absceso del psoas derecho, los cuales se trataron con antibioticoterapia y drenaje percutáneo del absceso, con resultados satisfactorios. El absceso del psoas secundario puede constituir el debut de una apendicitis atípica retrocecal, y para su diagnóstico hay que tener un alto nivel de sospecha por su clínica inespecífica.

The psoas abscess is a rare infectious disease that is difficult to diagnose, characterized by a purulent collection at the level of this muscle, which causes a systemic inflammatory response syndrome. The infection can be primary by hematogenous dissemination, or secondary, from a nearby infectious focus. Its presentation during pregnancy is rare, and the primary form predominates, which is why it was decided to write this article. The case of a pregnant woman with a gestational age of 28.4 weeks who was admitted due to inguinal pain with subsequent irradiation to the right hip, flank, and lumbar region; flexed posture of the right hip and analgesic gait, as well as the appearance, nine days after the onset of symptoms, of a painful mass between the right iliac fossa and flank it is presented. The findings of the abdominal ultrasound and MRI allowed the diagnosis of an appendiceal plastron with a retrocecal appendix, as well as a right psoas abscess, which were treated with antibiotic therapy and percutaneous drainage of the abscess, with satisfactory results. Secondary psoas abscess may constitute the debut of atypical retrocecal appendicitis, and its diagnosis requires a high level of suspicion due to its non-specific symptoms.

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BACKGROUND: Psoas abscess is a challenging disease that may sometimes lead to a devastating prognosis. Early diagnosis and treatment are mandatory for better results in their treatments and to avoid complications. PURPOSE: There is no article regarding a fibrosis treatment of the psoas muscle with a psoas abscess that is treated with full endoscopic debridement (FED). STUDY DESIGN: a case report and literature review. RESULT: we successfully treated this case, who suffered from psoas fibrosis with a clinical and MRI diagnosis, with full endoscopic debridement. CONCLUSIONS: FED is a viable alternative to open debridement for this rare complication of a psoas muscle abscess.

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Introducción: Presentamos el caso de un paciente masculino de 29 años con absceso del psoas bilateral secundario a tuberculosis vertebral. El absceso del psoas no suele ser frecuente en pacientes con tuberculosis extrapulmonar y principalmente con la enfermedad de Pott, pero cuando aparece suele ser subdiagnosticado debido a la inespecificidad de sus manifestaciones clínicas. Objetivos: Abordaje clínico-quirúrgico del absceso del psoas secundario a la tuberculosis vertebral, o Mal de Pott. Materiales y métodos: Búsqueda bibliográfica efectuada en pubmed. Relato de caso clínico: registro clínico y fotográfico, evolución, presentación de: resultados laboratoriales y de métodos auxiliares y tratamiento. Resultados: Síntomas presentados por un paciente de 29 años: dolor abdominal, dolor en miembro inferior, lumbalgia, expectoración sanguinolenta, dificultad en la deambulación, y cuadro respiratorio previo y síntomas constitucionales como pérdida de peso, anorexia, astenia. Con base en la anamnesis, examen físico y hallazgos en exámenes específicos, se pudo lograr el diagnóstico de absceso del psoas secundario a la tuberculosis vertebral. El tratamiento farmacológico seguido fue el propuesto por la OMS para la Tuberculosis más punción del absceso para drenaje y cultivo del mismo, con catéter multipropósito. El paciente tuvo una evolución favorable y posterior a la intervención neuroquirúrgica fue dado de alta. Conclusión: El paciente evolucionó de forma favorable, y las medidas aplicadas en el desarrollo de su enfermedad, fueron oportunas.

Introduction: We present de case of a 29 year old male patient with bilateral psoas abscess secondary to vertebral tuberculosis. Psoas abscess is not usually frequent in patient with extra-pulmonary tuberculosis and specially Pott's disease, but when it appears it is usually under diagnosed due to non-specificic clinical manifestations. Objectives: Clinical-surgical approach to psoas abscess secondary to vertebral tuberculosis, or Pott's disease. Materials and methods: Bibliographic search carried out in pubmed. Case report: clinical and photographic record, evolution and presentations of laboratory results, diagnostic auxiliary methods and treatment. Results: Symptoms presented by a 29 years old patient: abdominal pain, lower limb pain, low back pai, bloody expectoration, difficulty walking and previous respiratory and constitutional symptoms sucha as weight loss, anorexia, asthenia. Based on the clinicalhistory, physical examination and findins in specific tests, the diagnosis of psoas abscess secondary to vertebral tuberculosis could be achieved. The pharmacological treatment followed was the one proposed by WHO for tuberculosis, plus the drainage and culture of the abscess, with a multipurpose catheter. The patient had a favorable evolution and after the neurosurgical intervetntion he was discharged. Conclusion: The patient evolved favorably, and the measures applied in the development of his disease were appropriate.

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INTRODUCTION: Psoas abscess is a rare pathological entity being retroperitonescopy an unusual therapeutic modality for its resolution. MATERIALS AND METHODS: The objective is to present and describe five patients with a diagnosis of psoas abscess that were resolved by retroperitoneoscopy in our institution and then carried out a non-systematic review of the literature. RESULTS: The mean age was 58.8 years and 80% were male. All patients had back pain and none had therapeutic resolution with conservative treatment. 60% of the patients had a methicillin sensitive Staphyylococus Aureus. In the follow-up with a mean of 10.2 months, no recurrence was observed. CONCLUSIONS: Early diagnosis of psoas abscess is important for its correct resolution. In our small series of patients, retroperitoneoscopy was an effective treatment.

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INTRODUCCIÓN Haemophilus parainfluenzae (HP) es un cocobacilo gram negativo y un patógeno oportunista. Rara vez se asocia a infecciones vertebrales o musculoesqueléticas, y está muy poco reportado en la literatura. PRESENTACIÓN DELO CASO Una mujer de 45 años, sana, que presentaba un historial de dos semanas de lumbalgia progresiva, fiebre, coriza y congestión nasal, y que tenía discitis intervertebral causada por HP, confirmada por dos hemocultivos positivos y hallazgos progresivos de resonancia magnética (RM) de columna lumbar. Los hallazgos de la RM fueron atípicos, y consistían en un absceso del psoas y pequeñas colecciones de líquido epidural e intraespinal anterior asociadas con espondilodiscitis. El diagnóstico inicial se retrasó debido a que la RM inicial no reveló hallazgos que sugirieran un proceso infeccioso. El tratamiento consistió en un ciclo prolongado de administración intravenosa seguida de antibióticos orales, lo que finalmente produjo una buena respuesta clínica. DISCUSIÓN Y CONCLUSIÓN El HP es un patógeno muy raro en la espondilodiscitis. No obstante, debe tenerse en cuenta, especialmente en pacientes que presentan lumbalgia y fiebre y/o bacteriemia por microorganismos gram negativos. El estudio inicial debe incluir una RM de la columna con contraste. Aunque es poco común, la espondilodiscitis y un absceso del psoas pueden presentarse concomitantemente. Los antibióticos prolongados son el pilar del tratamiento.

INTRODUCTION Haemophilus parainfluenzae (HP) is a gram-negative coccobacillus and an opportunistic pathogen. It is rarely associated with spinal- and musculoskeletal-site infections, and very little reported in the literature. CASE PRESENTATION An otherwise healthy, 45-year-old woman who presented with a two-week history of progressive low back pain, fever, coryza and nasal congestion, was found to have intervertebral discitis caused by HP, confirmed by two positive blood cultures and progressive lumbar spine magnetic resonance imaging (MRI) findings. The MRI findings were atypical, consisting of a psoas abscess and small anterior epidural and intraspinal fluid collections associated with spondylodiscitis. The initial diagnosis was delayed because the initial MRI failed to reveal findings suggestive of an infectious process. The treatment consisted of a long course of intravenous followed by oral antibiotics, ultimately yielding a good clinical response. DISCUSSION AND CONCLUSION Haemophilus parainfluenzae is a very rare pathogen in spondylodiscitis. Nonetheless, it should be considered, especially in patients presenting with low back pain and fever and/or gram negative bacteremia. The initial work-up should include contrast-enhanced MRI of the spine. Although rare, spondylodiscitis and a psoas abscess can present concomitantly. Prolonged antibiotics are the mainstay of treatment.

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Los abscesos del psoas ilíaco secundarios a un tumor de colon fistulizado son excepcionales y potencialmente graves. La mayoría son adenocarcinomas de tipo mucinoso. Su tratamiento es complejo ya que, para lograr una resección oncológica pretendidamente curativa, es necesario realizar una resección ampliada con mayor morbimortalidad. Presentamos el caso de una paciente con un adenocarcinoma mucinoso de colon izquierdo fistulizado al músculo ilíaco y la pared anterolateral del abdomen en la que se realizó una resección multivisceral que incluyó el colon izquierdo, el músculo y la cresta ilíaca y parte de la pared anterolateral del abdomen.

Iliopsoas abscess secondary to perforation of colon cancer is an extremely rare and potentially life-threatening condition. Most tumors are mucinous adenocarcinomas. Its treatment its complex, as most patients need radical extended resections to achieve good oncological results, which are in turn, graved with higher morbidity and mortality. We present the case of a patient with a left colon mucinous adenocarcinoma penetrating to the iliopsoas muscle and the anterolateral abdominal wall that required a multivisceral resection including left colon, iliac muscle and crest and part of the anterolateral abdominal wall.

Abscessos do iliopsoas secundários a um tumor de cólon fistulizado são raros e potencialmente graves. A maioria são adenocarcinomas do tipo mucinoso. Seu tratamento é complexo, pois, para se obter uma ressecção oncológica supostamente curativa, é necessário realizar uma ressecção ampliada com maior morbimortalidade. Apresentamos o caso de um paciente com adenocarcinoma mucinoso de cólon esquerdo fistulizado para o músculo ilíaco e parede ântero-lateral do abdome no qual foi realizada ressecção multivisceral que incluiu cólon esquerdo, músculo e crista ilíaca e parte do a parede anterolateral do abdome.

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CASE: We present a case of a 70-year-old woman with simultaneous periprosthetic joint infection (PJI) of both hips and left knee due to a bilateral psoas abscess. The patient underwent debridement and implants removal with the consequent reimplantation in a sequential six-stage revision surgery. At four years of follow-up and in spite of the patient's comorbidities and current PJI presentation, she maintains full activities of daily living without restrictions. CONCLUSION: Accurate and early diagnosis of a psoas abscess is crucial. This case report provides experience of a complex scenario, the decision-making involved and the outcomes of an underdiagnosed complication.

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SUMMARY OBJECTIVE: We describe the case of a diabetic patient who developed vertebral osteomyelitis and bilateral psoas abscess with gas formation due to klebsiella pneumoniae. METHODS: A 64-year-old woman with a 4-year history of type-2 diabetes mellitus was admitted to the Emergency Department. The subject had a 2-day history of high-grade fever associated with chills and a 5-hour history of consciousness. She received empirical treatment with febrifuge, after which her fever decreased. RESULTS: Her fever recurred after an interval of three hours. A computed tomography scan of the abdomen revealed vertebral osteomyelitis and bilateral psoas muscle abscess with gas formation. Blood culture and purulent fluid described the growth of the Klebsiella pneumoniae. The patient received antibiotic therapy and bilateral drainage therapy after the drainage catheter was placed into the abscess cavity by CT-guidance. Due to the serious damage to the vertebral column and permanent pain, the patient underwent minimally invasive internal spinal fixation and recovered successfully. CONCLUSION: A case of vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Antibiotic therapy, drainage, and minimally invasive internal spinal fixation were performed, which enabled a good outcome.

RESUMO OBJETIVO: Descrever o caso de uma paciente diabética que desenvolveu osteomielite vertebral e abcesso bilateral do psoas com formação de gás causada por klebsiella pneumoniae. MÉTODOS: Uma mulher de 64 anos de idade, com 4 anos de histórico de diabetes mellitus tipo 2, foi admitida no Serviço de Emergência. A paciente apresentava um quadro de dias de febre alta acompanhada de calafrios e um histórico de 5 horas de consciência. Ela recebeu tratamento empírico com antitérmico, após o qual a febre diminuiu. RESULTADOS: A febre retornou após um intervalo de três horas. Uma tomografia computadorizada do abdome revelou osteomielite vertebral e abcesso bilateral do músculo psoas com formação de gás. A cultura do sangue e o fluido purulento revelaram o crescimento de Klebsiella pneumoniae. A paciente recebeu antibióticos e terapia de drenagem bilateral após o cateter de drenagem ser posicionado na cavidade do abscesso com auxílio de TC. Devido a sérios danos à coluna vertebral e a dor permanente, a paciente foi submetida à fixação vertebral interna minimamente invasiva e recuperou-se com sucesso. CONCLUSÃO: Um caso de osteomielite vertebral e abscesso do psoas bilateral com a formação de gás causada por Klebsiella pneumoniae em uma paciente diabética. Antibioticoterapia, drenagem e fixação vertebral interna minimamente invasiva foram realizadas, o que permitiu um bom resultado.

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The association of Comamonas kerstersii with peritonitis resulting from perforated appendix and its isolation from a psoas abscess and pelvic peritonitis have previously been described by us. We present the first case of C. kerstersii urinary tract infection, broadening the spectrum of infections caused by this species.

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El absceso de psoas es una enfermedad relativamente rara. Muchos casos presentan características clínicas atípicas. El absceso de psoas puede ser primario en pacientes inmunodeprimidos o secundario a infecciones gastrointestinales y genitourinarias. En los países no desarrollados, la mayoría de estos pueden ser de etiología tuberculosa. Una alta sospecha clínica, una buena historia clínica y estudios de imagen, pueden ser útiles en el diagnóstico y tratamiento de la enfermedad. El tratamiento temprano con antibióticos, drenaje guiado o cirugía abierta es necesario debido a su alta morbimortalidad. Se reporta el caso de un paciente varón de 57 años con historia de Diabetes mellitus (DM) de 20 años de evolución, quien refiere dolor en región lumbar izquierda asociada a aumento de volumen y fiebre intermitente, por lo que se hospitaliza, detectándose un absceso de psoas izquierdo, el cual es drenado por cirugía abierta con abordaje extra-peritoneal, presentando evolución favorable.

Psoas abscess is a relatively rare disease. Many cases present atypical clinical features. Psoas abscess may be primary in immunosuppressed patients or secondary to gastrointestinal and genitourinary infections. In non-developed countries most of these can be of tuberculous etiology. A high clinical suspicion, a good clinical history and imaging studies can be useful in diagnosing the disease. Early treatment with antibiotics, guided drainage or open surgery is necessary due to its high morbidity and mortality. It's reported the case of a male patient of 57 years with a history of diabetes mellitus (DM) of 20 years of evolution, who referred pain in the left lumbar region associated with increased volume and intermittent fever, so he is hospitalized, detecting an extensive left psoas abscess which is drained by open surgery with extraperitoneal approach, showing favorable evolution.

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ABSTRACT The aim of this study were to describe the technique of percutaneous drainage of iliopsoas abscess, and to discuss the benefits of using this minimally-invasive tool. A single center study with retrospective analysis of patients with psoas abscess confirmed by imaging scans, sent to the interventional medicine center and submitted to computed tomography and ultrasound-guided percutaneous drainage, from November 2013 to August 2016. Seven patients underwent percutaneous drainage of psoas abscess in this period. The mean initial drained volume was 61.4±50.7mL (ranging from 10 to 130mL), and the mean drainage duration was 8.3±2.8 days (ranging from 4 to 12 days). The success rate of the percutaneous procedures was 71.5%, and two patients required re-intervention. Image-guided percutaneous drainage of iliopsoas abscess is a minimally invasive, efficient and safe procedure, and an extremely valuable technique, especially for patients who are not suitable for surgical repair.

RESUMO Os objetivos deste estudo foram descrever a técnica de drenagem percutânea de abscesso de iliopsoas e discutir os benefícios do uso desta ferramenta minimamente invasiva. Trata-se de estudo unicêntrico com análise retrospectiva de pacientes com abscesso de psoas confirmado por exames de imagem, encaminhados a um centro de medicina intervencionista e submetidos à drenagem percutânea guiada por tomografia computadorizada e ultrassonografia, de novembro de 2013 a agosto de 2016. Sete pacientes foram submetidos à drenagem percutânea de abscesso de psoas no período avaliado. O volume drenado inicial médio foi 61,4±50,7mL (variação de 10 a 130mL), e a duração média da drenagem foi de 8,3±2,8 dias (variação de 4 a 12 dias). A taxa de sucesso dos procedimentos percutâneos foi 71,5%, e dois pacientes necessitaram de reintervenção. A drenagem percutânea guiada por imagem de abscesso de iliopsoas é um procedimento minimamente invasivo, eficiente e seguro, além de ser uma técnica muito valiosa, especialmente em pacientes que não são candidatos à abordagem cirúrgica.

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The association of Comamonas kerstersii with peritonitis resulting from the presence of perforated appendix has previously been described by our research team. In the present study, we describe the isolation of this microorganism from two forms of unusual presentations of C. kerstersii infection not previously described in the literature: localized intra-abdominal infection (psoas abscess) and pelvic peritonitis.

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El absceso del psoas es una enfermedad infrecuente en niños. Puede tener una presentación clínica inespecífica, ser de inicio insidioso y relacionarse o no con fiebre. El tipo más frecuente en pediatría es primario; sin embargo, en ocasiones, puede ser de origen secundario y asociarse a infecciones graves, como la osteomielitis, por lo que se requiere un alto índice de sospecha para detectarlo y tratarlo oportunamente. Presentamos un caso atípico de absceso del psoas con infiltración del cuerpo vertebral de L2 en un paciente masculino de 14 años previamente sano, sin antecedente de traumatismo ni fiebre al momento del ingreso. Se realizaron una radiografía y una ecografía, pero el diagnóstico se confirmó a través de una resonancia nuclear magnética de columna lumbosacra. Conhemocultivos positivos para Staphylococcus aureus meticilino resistente, completó 2 semanas de tratamiento antibiótico endovenoso y 4 semanas por vía oral con negativización de cultivos y resolvió por completo la sintomatología inicial.

Psoas abscess is a common disease in children. It can have a nonspecific clinical presentation, insidious onset and sometimes fever. The most common type in children is the primary one; however, it can sometimes be of secondary origin and associated with severe infections such as osteomyelitis so a high index of suspicion is required to detect and treat it promptly. We present an unusual case of psoas abscess with infiltration of the vertebral body of L2 in a 14 year old male patient previously healthy with no history of trauma or fever on admission. X-ray and ultrasound were performed but the diagnosis was confirmed by magnetic resonance imaging of the lumbosacral spine. With positive blood cultures for methicillin-resistant Staphylococcus aureus he completed 2 weeks of intravenous antibiotic therapy and 4 weeks of oral antibiotic therapy with blood cultures negativization and resolution of symptoms.

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Psoas abscess is a common disease in children. It can have a nonspecific clinical presentation, insidious onset and sometimes fever. The most common type in children is the primary one; however, it can sometimes be of secondary origin and associated with severe infections such as osteomyelitis so a high index of suspicion is required to detect and treat it promptly. We present an unusual case of psoas abscess with infiltration of the vertebral body of L2 in a 14 year old male patient previously healthy with no history of trauma or fever on admission. X-ray and ultrasound were performed but the diagnosis was confirmed by magnetic resonance imaging of the lumbosacral spine. With positive blood cultures for methicillin-resistant Staphylococcus aureus he completed 2 weeks of intravenous antibiotic therapy and 4 weeks of oral antibiotic therapy with blood cultures negativization and resolution of symptoms.

El absceso del psoas es una enfermedad infrecuente en niños. Puede tener una presentación clínica inespecífica, ser de inicio insidioso y relacionarse o no con fiebre. El tipo más frecuente en pediatría es primario; sin embargo, en ocasiones, puede ser de origen secundario y asociarse a infecciones graves, como la osteomielitis, por lo que se requiere un alto índice de sospecha para detectarlo y tratarlo oportunamente. Presentamos un caso atípico de absceso del psoas con infiltración del cuerpo vertebral de L2 en un paciente masculino de 14 años previamente sano, sin antecedente de traumatismo ni fiebre al momento del ingreso. Se realizaron una radiografía y una ecografía, pero el diagnóstico se confirmó a través de una resonancia nuclear magnética de columna lumbosacra. Conhemocultivos positivos para Staphylococcus aureus meticilino resistente, completó 2 semanas de tratamiento antibiótico endovenoso y 4 semanas por vía oral con negativización de cultivos y resolvió por completo la sintomatología inicial.

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INTRODUCTION: Psoas abscess is a rare clinical entity with vague symptomatology. We report a psoas abscess that simulated symptoms of acute appendicitis. PRESENTATION OF CASE: A twenty-five year old male presented pain irradiating to the right iliac fossa and lumbar region associated with thigh flexion. Laboratorial exams revealed leukocytosis with a neutrophil shift to the left. Abdominal Ultrasound showed significant intestinal distension and a small quantity of free fluid at the right iliac fossa. Laparotomy and an appendectomy were performed. During immediate post-operative, the patient evolved with worsening of the pain and the leukocytosis, therefore, we chose to maintain his antalgic posture. An abdominal Computerized Tomography scan with contrast was solicited, revealing an increase of the iliac and psoas muscles of the right side, and multiple bacterial focuses. A retroperitoneal access was performed and 300ml of purulent secretion was drained. Afterwards, we implanted a Penrose Drain. The patient had a good post-op evolution, being discharged 7days after the drainage. DISCUSSION: The psoas muscle is a flexor of the thigh. Psoas abscess is an underdiagnosed condition, its main treatment is surgery associated with antibiotic therapy. CT scan seems to be the best choice of diagnostic image exam, although some authors prefer the nuclear magnetic resonance. CONCLUSION: The psoas muscle abscess is uncommon and poorly characterized in its etiology, clinical associations, and its therapeutic approach. On the other hand, acute appendicitis is the most common abdominal emergency, with a 7% death rate, and surgery is its main treatment.

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Staphylococcus lugdunensis is a coagulase-negative staphylococcus of growing importance and atypical behavior. The infections caused by this microorganism are becoming more frequent, having a broader spectrum. Psoas abscesses caused by this germ are rare, with few cases reported in the literature. In this work, we present a case of a psoas abscess caused by S. lugdunensis in a patient suffering from diabetes mellitus and rheumatoid arthritis, which was treated with intravenous cloxacillin with a good outcome.

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El absceso del músculo psoas ilíaco suele ser causa infrecuente de fiebre de origen desconocido en pacientes sanos. Sin embargo, su incidencia asciende en pacientes portadores de enfermedades debilitantes como la diabetes mellitus. Se presentó a una paciente diabética portadora de fiebre de origen desconocido, de seis meses de evolución, con diagnóstico final de absceso del psoas. La paciente, de 52 años de edad, ES portadora de diabetes mellitus tipo 1, complicada con uropatía litiásica obstructiva bilateral, infecciones urinarias a repetición, operada de pionefrosis y absceso renal derecho a los 33 años de edad, secundario a infección urinaria ascendente por Klebsiella pneumoniae. Se reintervinió por absceso recidivante a Klebsiella, adquirida por igual vía urinaria, pero esta vez con un absceso por contigüidad del músculo psoas ilíaco izquierdo, tras un período de fiebre de origen desconocido, de seis meses de evolución. La atipicidad de este caso radica en la recidiva de abscesos retroperitoneales profundos por Klebsiella y la forma insidiosa de presentación del actual absceso del psoas.

The abscess of the iliac psoas muscle uses to be the infrequent cause of unknown origin fever in healthy patients. Nevertheless, its incidence increases in patients who carry debilitating diseases as diabetes mellitus. The case presented deals with a female diabetic patient showing fiver of unknown origin already for six months, with final diagnosis of psoas abscess. The patient, aged 57 years, has type I diabetes mellitus, complicated with bilateral obstructive lithiasic uropathy and reiterative urinary infections. At the age of 33, she was operated of pyonephrosis and right renal abscess secondary to ascendant urinary infection by Klebsiella pneumoniae. She was operated again for recidivist abscess to Klebsiella, acquired through the urinary tract, but this time it was an abscess contiguous to left iliac psoas muscle, after a six-month evolution period of unknown origin fever. The unusualness of this case consists in the recidivism of deep retroperitoneal abscesses by Klebsiella and the insidious presentation form of the current psoas abscess.

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Introducción: El absceso del psoas es un cuadro infrecuente cuyo principal agente etiológico es el Staphyloccocus aureus, y que con baja frecuencia puede ser de etiología tuberculosa como complicación de una afección vertebral por Mycobacterium tuberculosis. Presentación del caso: Mujer de 58 años, mapuche, con antecedentes de enfermedad pulmonar obstructiva crónica y alcoholismo crónico, consultó por cuadro de dos meses de evolución de dolor lumbar, baja de peso y paresia de extremidad inferior derecha que impedía la marcha. Tomografía computada (TC) de columna evidenció espondilodiscitis y absceso del psoas derecho, iniciándose tratamiento antibiótico cubriendo Staphyloccocus aureus. Los hemocultivos y los cultivos de la colección resultaron negativos por lo que se decidió mantener tratamiento ambulatorio. Paciente consultó cuatro meses después por exacerbación de su disnea basal de dos semanas de evolución, radiografía de tórax y TC de tórax de alta resolución compatibles con tuberculosis pulmonar con diseminación miliar bilateral, por lo cual, se inició tratamiento antituberculoso, realizándose baciloscopías que resultaron negativas. Además, se solicitó identificación del bacilo de Koch mediante reacción de polimerasa en cadena que resultó positiva, con lo que se confirmó el diagnóstico de tuberculosis miliar y mal de Pott. Se decidió reevaluar con TC de columna una vez finalizado el tratamiento antituberculoso para decidir conducta quirúrgica. Discusión: Es importante la sospecha activa de etiología tuberculosa ante una espondilodiscitis y un absceso del psoas, pese a su baja frecuencia. El inicio del tratamiento en forma precoz puede modificar la progresión de una infección que puede ser invalidante e incluso mortal.

Introduction: The Psoas abscess is an infrecuent condition which main ethiology is the Staphyloccocus aureus and with less frequency can be a vertebral tuberculosis complication caused by Mycobacterium tuberculosis. Case Report: a 58 years old female, Mapuche, with Chronic Obstructive Pulmonar Disease and chronic alcoholism antecedents, was admitted in the emergency room with a two month old lumbar pain, loss of weight and right inferior extremity paresia which didn't allowed her to walk. The column's Computed Tomography (CT) showed spondylodiscitis and a right psoas abscess, the antibiotherapy, covering Staphyloccocus aureus, was started. The hemoculives and abscess' cultives were negative, so it was decided to continue with ambulatory treatment. The patient was admitted four month later because of two weeks of exacerbation of her basal dysnea. The thorax Radiography and high resolution CT were compatibles with pulmonary tuberculosis with bilateral miliar disemination. Antituberculosis treatment was started, bacilloscopies were negative, also, a Polymerase Chain Reaction identification of Koch's bacillus was performed, resulting positive, confirming the diagnosis of miliar tuberculosis and Pott's disease. Once antituberculosis treatment was finished, a new column's CT was requested to decided surgical conduct. Discussion: Is important to actively suspect of tuberculosis ethiology in presence of spondylodiscitis and psoas abscess, despite it's low frequency. The early treatment start may modify the progresion of an infección that can be invalidating and even mortal.

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RESUMO

El absceso del músculo psoas es una piomiositis infrecuente en la población pediátrica, convirtiéndose en un gran reto diagnóstico. Esta condición debe sospecharse en todo niño con fiebre, malestar general o dolor abdominal, lumbar o de cadera con evolución mayor a una semana. Suele confundirse con artritis séptica u otras enfermedades osteomusculares, por lo que se requiere de la realización de imágenes diagnósticas; el desconocimiento de esta patología retrasa el inicio del tratamiento y genera gran morbimortalidad. Se presenta un caso atendido en un centro hospitalario pediátrico de tercer nivel de Bogotá, D.C. y se hace una revisión de la literatura enfatizando sus claves diagnósticas y el manejo terapéutico.

Psoas Abscess is a pyomyositis rarely present, which in turn makes its diagnosis a real challenge. This condition must be a differential diagnosis in children presenting fever, general malaise, lumbalgia, abdominal or hip pain for more than a week. It is frequently confused with septic arthritis or other musculoskeletal diseases, which is why radiographic studies or ultrasonography are necessary. Unawareness of this pathology delays its treatment, thus producing high levels of morbidity and mortality. A clinical case treated in a pediatric hospital from Bogotá, Colombia, is presented, as well as a literature review emphasizing in Psoas Abscess key issues and treatment.