Psoas Abscess Mimicking Sacroiliitis in a Patient with Ankylosing Spondylitis: a Case Report
SN Comprehensive Clinical Medicine, cilt.4, sa.1, 2022 (Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 4 Sayı: 1
- Basım Tarihi: 2022
- Doi Numarası: 10.1007/s42399-022-01266-2
- Dergi Adı: SN Comprehensive Clinical Medicine
- Derginin Tarandığı İndeksler: Scopus, EMBASE
- Anahtar Kelimeler: Ankylosing spondylitis, Case report, Percutaneous drainage, Psoas abscess, Sacroiliitis
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
In patients with ankylosing spondylitis (AS) who develop sudden and severe low back pain, serious causes such as infections, spinal instability, and vertebral fractures should be considered in the differential diagnosis. A 34-year-old male patient with AS, who was previously in remission for the past 2 years (last visit was 3 months ago), presented with severe low back pain and limping. He had bilateral sacroiliitis on magnetic resonance imaging (MRI) taken at another center recently on his admission. Visual analog scale score was 10 and Bath Ankylosing Spondylitis Disease Activity Index score was 9.6. In laboratory evaluation, C-reactive protein (CRP) level was 13 mg/dl and leukocyte count was 17,000/uL. After blood and urine cultures, tuberculosis and brucella tests were taken, and prophylactic antibiotic treatment was given. In MRI, a multiloculated abscess formation which starts from the left S1 level and extends along the posterior of the iliopsoas muscle and presses on the bladder and prostate was observed. Percutaneous abscess drainage was performed under the guidance of computed tomography (CT). There was a rapid improvement in pain scores and acute phase reactants following abscess drainage. After 2 weeks, a significant regression of abscess formation was seen in the control CT evaluation. Red flags should be checked in patients with AS who have severe low back pain unresponsive to routine treatment and other causes of low back pain should not be ignored.