Korean J Urol.  2013 Nov;54(11):801-804.

Psoas Abscess Secondary to Renal Tuberculosis in a Middle-aged Woman

• Lee SW

Abstract

A psoas muscle abscess is a relatively uncommon condition that can present with vague clinical features. With the decreasing prevalence of tuberculosis, psoas abscesses of tuberculous origin are currently rare in developed countries, but are typically caused by tuberculosis of the spine. Here, an unusual case of a psoas abscess secondary to renal tuberculosis in a middle-aged woman is presented. The abscess was successfully treated with percutaneous drainage followed by nephrectomy and additional antituberculous medications.

Keyword

Abdominal pain; Psoas abscess; Renal tuberculosis

MeSH Terms

Abdominal Pain
Abscess
Developed Countries
Drainage
Female
Humans
Nephrectomy
Prevalence
Psoas Abscess*
Psoas Muscles
Spine
Tuberculosis
Tuberculosis, Renal*

Figure

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  FIG. 1 Abdominal plain radiograph showed extensive lobulated calcifications on the right renal shadow, suggestive of an autonephrectomized tuberculous kidney. Other calcifications were also observed on the expected course of the right upper ureter.

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  FIG. 2 (A) Abdominal computed tomographic (CT) scan better demonstrated the right autonephrectomized kidney. The CT scan also revealed abscess-like collections measuring 6 cm×4 cm×8 cm in the right psoas muscle. The collections of the psoas muscle extended from the right kidney through the posterior pararenal area. (B) An axial CT image at a slightly lower level showed the displaced right kidney abutting the anterior abdominal wall. The CT scan finings suggested that the palpable mass in the right upper quadrant on the physical examination was probably the right kidney, displaced anteriorly.

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  FIG. 3 (A) A histopathological section of the nephrectomized specimen showed chronic granulomatous inflammation with caseous necrosis. Multinuclear giant cells were also seen (H&E, ×100). (B) The histopathological examination of the specimen from the remaining psoas abscess also revealed chronic granulomatous inflammation (arrow). Skeletal muscle cells of the psoas muscle are observed on the left.

Reference

1. Harrigan RA, Kauffman FH, Love MB. Tuberculous psoas abscess. J Emerg Med. 1995; 13:493–498.

2. Walsh TR, Reilly JR, Hanley E, Webster M, Peitzman A, Steed DL. Changing etiology of iliopsoas abscess. Am J Surg. 1992; 163:413–416.

3. Wise GJ, Marella VK. Genitourinary manifestations of tuberculosis. Urol Clin North Am. 2003; 30:111–121.

4. Gallucci M, Alpi G, Ricciuti GP, Ferrone G, Fagioli A, Bernabai CF. Abscess of the psoas muscle and of the thigh secondary to a mastic-like tuberculous kidney. Minerva Urol Nefrol. 1985; 37:311–313.

5. Figueiredo AA, Lucon AM. Urogenital tuberculosis: update and review of 8961 cases from the world literature. Rev Urol. 2008; 10:207–217.

6. Chern CH, Hu SC, Kao WF, Tsai J, Yen D, Lee CH. Psoas abscess: making an early diagnosis in the ED. Am J Emerg Med. 1997; 15:83–88.

7. McAleer SJ, Johnson CW, Johnson WD Jr. Tuberculosis and parasitic and fungal infections of the genitourinary system. In : Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders;2007. p. 436–447.

8. Lee JY, Park HY, Park SY, Lee SW, Moon HS, Kim YT, et al. Clinical characteristics of genitourinary tuberculosis during a recent 10-year period in one center. Korean J Urol. 2011; 52:200–205.