SECONDARY PSOAS ABSCESS: CASE REPORT ABOUT A PATIENT WITH AIDS AND REVIEW OF THE LITERATURE

Abstract

Psoas abscess is a disease which is often misdiagnosed, since it has ambiguous symptoms; this fact may be responsible for delays in diagnostic and consequent evolution to a serious form of the disease, which may be a threat to the patient’s life. The purpose of this work is to present a clinical case of psoas abscess of difficult diagnostic and discuss the findings in this case and in the literature. The work reports a case involving a 69 year old married male patient, who was interned in the emergency unit at Hospital Universitário do Norte do Paraná. At admission the patient presented symptoms which were not specific, such as fever, loss of weight and abdominal pain. The diagnostic was carried out by utilizing the clinical findings associated to a complete abdominal ultrasound scan (USS); however, in the follow up phase an additional computerized tomography (CT) of the abdomen was utilized. Treatment consisted of surgical draining carried out on the 8th day of internment associated to systemic venous antibiotic therapy. In spite of such treatment the patient presented a surgical incision abscess on the 30th day after surgery, which was drained again. Since then, a fistula originated at such incision, which was characterized by regressions and relapses. On the 59th day after surgery, the patient was again interned due to fever, and the physical examination revealed the existence of a tumor in the lower right hip and a fistula on the surgical incision. After laboratory exams, the presence of oral moniliasis was confirmed, as well as tuberculosis bacillus in the secretion of the fistula, and positive serology to Human Immunodeficiency Virus (HIV) and specific treatment for these diseases were started. On his latest return to the ambulatory, after twenty seven months of follow up, the patient continued to be treated for AIDS; nevertheless, he was enjoying excellent health and was active again.