Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Primary bilateral iliopsoas abscesses in the elderly are very rare in Europe. We report a case of an elderly male misdiagnosed with rheumatic low back pain. The delay in accurate diagnosis and therapy led to severe worsening of his general condition and septic shock. The diagnosis was established by multi-slice computed tomography (MSCT) and the patient was successfully treated by MSCT-guided percutaneous drainage of both psoas muscles. Septic shock and miscellaneous complications required continuous intensive care. The patient was discharged after 42 days of hospital treatment. Antibiotic therapy continued for the next six weeks until his complete recovery. Pain remains the most frequent and predominant symptom of spinal pathology regardless of the etiology. Immunocompromised patients or signs suggestive of bacterial infection require caution and a more comprehensive diagnostic work-up.Primarni, bilateralni apsces bočnoslabinskog mišića (m. iliopsoasa) u starijih osoba vrlo je rijedak u Europi. Prikazujemo slučaj starijeg muškarca u kojeg je postavljena pogrešna dijagnoza križobolje. Zakašnjenje u utvrđivanju bilateralnog apscesa iliopsoasa i primjeni odgovarajuće terapije uzrokovalo je pogoršanje općeg stanja i septički šok. Dijagnoza je potvrđena multi-slice kompjutoriziranom tomografijom (MSCT), a bolesnik je uspješno liječen postavljanjem drena pod kontrolom MSCT u oba psoasa. Septički šok i druge popratne komplikacije zahtijevale su kontiunirani nadzor u Jedinici intenzivne skrbi. Bolesnik je otpušten kući nakon 42 dana hospitalizacije. Antibiotska terapija nastavljena je još šest tjedana nakon otpusta do potpunog oporavka. Bol ostaje najčešći i dominantni simptom bilo kojeg patološkog procesa u području kralježnice. Imunokompromitirani bolesnici kao i bolesnici sa znacima koji upućuju na bakterijsku infekciju zahtijevaju posebnu pažnju i širu dijagnostičku obradu
