CLINICAL IMAGE:
Urinary tract infection is a common condition, seldom presenting with
life-threathening manifestations. The iliopsoas muscle abscess may occur
by hematological/lymphatic dissemination or secondary to local
infections, namely rare situations of kidney infection.
A 75-years-old woman presented with altered mental state and one-week
complaints of liquid stools, decreased urinary output and abdominal
discomfort. On admission, she was hypotensive, tachycardic and had
abdominal pain in the right quadrants. Blood work showed anemia, acute
kidney injury and increased C-reactive protein. Urinalysis had
leukocyturia and she had an unremarkable abdominal/renal ultrasound. A
diagnosis of urossepsis was made and she was started on supportive care
and 3rd generation cephalosporin. Although Escherichia coli was isolated
on blood and urine culture, the patient maintained fever and persistent
aggravation, which led to switch of antibiotic on the 8th day and a
prompt radiological reevaluation. Abdominal computed tomography was
performed, revealing abscessed collections in the right iliopsoas muscle
(Figure 1), which was submitted to CT-directed drainage and posterior
isolation of Escherichia coli. The diagnosis of iliopsoas muscle abscess
by bacterial translocation secondary to urinary tract infection was
admitted. De-escalation of antibiotic was performed according to the
antibiogram and antibiotic maintained for eight weeks, leading to
apyrexia and clinical improvement.
Data Availability Statement: Data sharing is not applicable to this
article as no new data were created or analyzed in this study.
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