Tuberc Respir Dis.  2008 Dec;65(6):517-521.

A Case of Tuberculous Psoas Abscess Caused by Tuberculous Lymphadenopathy

• Park MY
• Park JY
• Yu JY
• Kim SS
• Kim MS
• Kim JC
• Ahn CJ

Abstract

A tuberculous psoas abscess is a frequently described complication of tuberculous spondylitis. Although rare, a tuberculous psoas abscess can develop without any demonstrable spinal involvement. In patients with no evidence of sponylitis, the abscess may result from direct spread from the involved lymph node or via a hematogeous route. The treatment of a psoas abscess is either drug therapy or surgical intervention in conjunction with drug therapy. Image-guided percutaneous drainage in conjunction with drug therapy is also a safe and effective treatment for a tuberculous psoas abscess. We report an unusual case of bilateral tuberculous psoas abscesses without any concomitant spinal involvement. The tuberculous psoas abscess may have formed by fistulization between the necrotic lymph node and psoas sheath. The diagnosis was confirmed by computed tomography and a histology examination of the biopsy sample. The patient improved after administering anti-tuberculous agents for 2 years along with surgical and percutaneous drainage of the abscess.

Keyword

Tuberculosis; Psoas abscess; Lymphadenopathy

MeSH Terms

Abscess
Biopsy
Drainage
Humans
Lymph Nodes
Lymphatic Diseases
Psoas Abscess
Spondylitis
Tuberculosis

Figure

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  Figure 1 (A) Abdomen dynamic CT show multiple large necrotic regions in both psoas muscle and well enhancing calcified enlarged lymph nodes in both iliac chains. Both psoas muscles diffusely enlarged with bulging contour due to multiple psoas abscess. Abdominal dynamic CT also shows communicaiton between the calcified, enhancing lymph node and the right psoas abscess. (B) T2-weighted axial image show multiple psoas abscess and focal bony erosion at right lateral aspect of L4 body. The focal bony erosion at L4 body may be due to inflammtion of psoas abscess.

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  Figure 2 (A) Right inguinal lymph node biopsy showing chronic granulomatous inflammation with collection of epithelioid cells and cuffing of lymphoplasma cells (H&E stain, ×200). (B) Psoas abscess biopsy showing chronic granulomatous inflammation with caseous necrosis and Langhans' giant cells consistent with tuberculosis (H&E stain, ×100).

Reference

1. Mückley T, Schütz T, Kirschner M, Potulski M, Hofmann G, Bühren V. Psoas abscess: the spine as a primary source of infection. Spine. 2003. 28:E106–E113.

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

4. Torres GM, Cernigliaro JG, Abbitt PL, Mergo PJ, Hellein VF, Fernandez S, et al. Iliopsoas compartment: normal anatomy and pathologic processes. Radiographics. 1995. 15:1285–1297.

5. Sanal HT, Kocaoglu M, Sehirlioglu A, Bulakbasi N. A rare cause of flank mass: psoas abscess due to extensive primary thoracolumbar tuberculous spondylodiskitis. AJNR Am J Neuroradiol. 2006. 27:1735–1737.

6. Dinç H, Ahmetoğlu A, Baykal S, Sari A, Sayil O, Gümele HR. Image-guided percutaneous drainage of tuberculous iliopsoas and spondylodiskitic abscesses: Midterm results. Radiology. 2002. 225:353–358.

7. Fitoz S, Atasoy C, Yagmurlu A, Akyar S. Psoas abscess secondary to tuberculous lymphadenopathy: case report. Abdom Imaging. 2001. 26:323–324.

8. Perros P, Sim DW, MacIntyre D. Psoas abscess due to retroperitoneal tuberculous lymphadenopathy. Tubercle. 1988. 69:299–301.

9. Younes M, Ben Ayèche ML, Béjia I, Ben Hamida R, Dahmène J, Moula T. Tubercular abscess of the psoas without associated spinal involvement: a case report. Rev Med Interne. 2002. 23:549–553.

10. Dahniya MH, Hanna RM, Grexa E, Cherian MJ, Niazy MN, Badr S, et al. Percutaneous drainage of tuberculous iliopsoas abscesses under image guidance. Australas Radiol. 1999. 43:444–447.

11. Tanomkiat W, Buranapanitkit B. Percutaneous drainage of large tuberculous iliopsoas abscess via a subinguinal approach: a report of two cases. J Orthop Sci. 2004. 9:157–161.

12. Atkin G, Qurashi K, Isla A. Laparoscopic drainage of bilateral tuberculous psoas abscesses. Surg Laparosc Endosc Percutan Tech. 2005. 15:380–382.

13. Ludwig B, Lazarus AA. Musculoskeletal tuberculosis. Dis Mon. 2007. 53:39–45.

14. Jutte PC, Rutgers SR, Van Altena R, Uges DR, Van Horn JR. Penetration of isoniazid, rifampicin and pyrazinamide in tuberculous pleural effusion and psoas abscess. Int J Tuberc Lung Dis. 2004. 8:1368–1372.