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Park, Park, Yu, Kim, Kim, Kim, and Ahn: A Case of Tuberculous Psoas Abscess Caused by Tuberculous Lymphadenopathy
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 65(6): 517-521.

Published online: 31 December 2008

DOI: https://doi.org/10.4046/trd.2008.65.6.517

A Case of Tuberculous Psoas Abscess Caused by Tuberculous Lymphadenopathy

Mi Youn Park, M.D.1, Jin Young Park, M.D.1, Ji Youn Yu, M.D.1, Seung Su Kim, M.D.1, Myung Sook Kim, M.D.1, Ji Chang Kim, M.D.2, Chang Joon Ahn, M.D.3

1Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea.

2Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea.

3Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea.

Address for correspondence: Myung Sook Kim, M.D. Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, 520-2, Daeheung-dong, Jung-gu, Daejeon 301-723, Korea. Phone: 82-42-220-9114, Fax: 82-42-252-6807, kims@catholic.ac.kr

Received 29 August 2008       Accepted 7 October 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

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.

Keywords: Tuberculosis, Psoas abscess, Lymphadenopathy

Figures and Tables

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.
trd-65-517-g001
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).
trd-65-517-g002

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