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Primary psoas abscess due to Streptococcus milleri.

Bagul NB, Abeysekara AM, Jacob S - Ann. Clin. Microbiol. Antimicrob. (2008)

Bottom Line: We also emphasises the importance of bacteriological confirmation of microorganism involved, although Staphylococcus aureus remains the commonest pathogen.We report an extremely rare case of PPA caused by Streptococcus milleri.Only one case has been reported in literature so far.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University Hospital of North Tees, Stockton, UK. drnitinbb@gmail.com

ABSTRACT
Primary Psoas abscess (PPA) is an infrequent clinical entity with obscure pathogenesis and vague clinical presentation. High index of clinical suspicion is required for the diagnosis of psoas abscess. We also emphasises the importance of bacteriological confirmation of microorganism involved, although Staphylococcus aureus remains the commonest pathogen. We report an extremely rare case of PPA caused by Streptococcus milleri. Only one case has been reported in literature so far.

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Related in: MedlinePlus

Computed tomogram of abdomen showing right psoas abscess abutting the right kidney.
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Figure 1: Computed tomogram of abdomen showing right psoas abscess abutting the right kidney.

Mentions: A 57-year-old man was admitted to hospital with seven-day history of right upper quadrant and loin pain radiating to right leg and umbilicus. Patient also complained of fever, chills, general malaise, decreased appetite. Patient denied any urinary symptoms. Patient had significant past medical history of coronary artery bypass surgery 5 years ago and laparoscopic cholecystectomy 2 years ago. On general examination he was pale, temp-37.5 degree Celsius. On physical examination he had fullness in right flank, which was tender and fluctuant. Laboratory investigation revealed leucocytosis of 14.9 × 109/l. Plain abdominal radiograph showed a soft tissue shadow on right upper quadrant. Ultrasonography (USS) guided aspiration was undertaken and 250 ml of thick brown blood stained pus was drained and sent for microscopy and culture. Drain was kept in situ. Microbiology reported SM as causative organism sensitive to penicillin and erythromycin. Patient was started on intravenous 1.8 g qds benzyl penicillin for 4 weeks. Computed Tomography (CT) and barium enema was performed to rule out bowel origin (Figure 1 &2). Magnetic resonance imaging scan was performed which showed abscess in posterior abdominal wall extending to retro peritoneum abutting the right kidney. Drain was removed in 20 days after ultrasound confirmation. The patient's general condition improved over a period of 28 days during the stay in hospital. Patient was subsequently discharge and on follow up of one year he is doing fine.


Primary psoas abscess due to Streptococcus milleri.

Bagul NB, Abeysekara AM, Jacob S - Ann. Clin. Microbiol. Antimicrob. (2008)

Computed tomogram of abdomen showing right psoas abscess abutting the right kidney.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2266777&req=5

Figure 1: Computed tomogram of abdomen showing right psoas abscess abutting the right kidney.
Mentions: A 57-year-old man was admitted to hospital with seven-day history of right upper quadrant and loin pain radiating to right leg and umbilicus. Patient also complained of fever, chills, general malaise, decreased appetite. Patient denied any urinary symptoms. Patient had significant past medical history of coronary artery bypass surgery 5 years ago and laparoscopic cholecystectomy 2 years ago. On general examination he was pale, temp-37.5 degree Celsius. On physical examination he had fullness in right flank, which was tender and fluctuant. Laboratory investigation revealed leucocytosis of 14.9 × 109/l. Plain abdominal radiograph showed a soft tissue shadow on right upper quadrant. Ultrasonography (USS) guided aspiration was undertaken and 250 ml of thick brown blood stained pus was drained and sent for microscopy and culture. Drain was kept in situ. Microbiology reported SM as causative organism sensitive to penicillin and erythromycin. Patient was started on intravenous 1.8 g qds benzyl penicillin for 4 weeks. Computed Tomography (CT) and barium enema was performed to rule out bowel origin (Figure 1 &2). Magnetic resonance imaging scan was performed which showed abscess in posterior abdominal wall extending to retro peritoneum abutting the right kidney. Drain was removed in 20 days after ultrasound confirmation. The patient's general condition improved over a period of 28 days during the stay in hospital. Patient was subsequently discharge and on follow up of one year he is doing fine.

Bottom Line: We also emphasises the importance of bacteriological confirmation of microorganism involved, although Staphylococcus aureus remains the commonest pathogen.We report an extremely rare case of PPA caused by Streptococcus milleri.Only one case has been reported in literature so far.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University Hospital of North Tees, Stockton, UK. drnitinbb@gmail.com

ABSTRACT
Primary Psoas abscess (PPA) is an infrequent clinical entity with obscure pathogenesis and vague clinical presentation. High index of clinical suspicion is required for the diagnosis of psoas abscess. We also emphasises the importance of bacteriological confirmation of microorganism involved, although Staphylococcus aureus remains the commonest pathogen. We report an extremely rare case of PPA caused by Streptococcus milleri. Only one case has been reported in literature so far.

Show MeSH
Related in: MedlinePlus