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Spondylodiscitis associated with Psoas Abscess

RESUMO

CASE PRESENTATION:42-year-old male, smoker, with hepatitis B. One year ago,suffered injury from trampling.Six months ago, presented insidious, diffuse and daily low back pain with progressive worsening relatedwith paresthesia in perineum, buttocks, thighs and feet.Ten days ago, reported decreased strength in the lower limbs and impaired gait. He denies fever and weight loss. The physical examination revealed left paravertebral hypertonia in L3-L4, pain on distal mobilization in bed, anti-algicand paretic gait and ortho support. Proximal strength in right lower limb 5/5 and distal 0/5, proximal strength in left lower limb 4/5 and distal 1/5, hypoactive and symmetrical osteotendinous reflexes, hypoesthesia in the bilateral plantar region. The lumbar spine and abdominal tomography (CT) showed L3-L4 spondylodiscitis, voluminous heterogeneous fluid collection in the left psoas muscle with intrasomatic extension in L2 that reaches spinal canal compressing nerve roots. The laboratory tests were normal and serological tests VDRL, HIV and IGRA were negative. Broad-spectrum antibiotics were started. Ultrasound-guided percutaneous lumbar puncture was performed with aspiration of 100 ml of purulent fluid that was sent for culture and showed no growth of bacteria. The CT control presented abscess remission and reduction of material in the spinal canal, besides improving the pain and gait. At discharge, antibiotic therapy was maintained with clindamycin and ciprofloxacin, putti vest and return for follow-up of spondylodiscitis.
DISCUSSION: With unspecific symptoms, low back pain due to spondylodiscitis may present with fever, claudication and prostration.Psoas abscess, secondary to infectious hematogenous lesions, tuberculosis, diabetes, tumors, and trauma, was the etiology of disc infection in our case.The diagnosis was confirmed by the history, neurological evaluation and imaging tests, with CT being the gold standard.Although we did not conclusively identify the origin of the abscess, an association with the trauma previously reported is valid.The treatmentwas based on abscess drainage, antibiotic therapy, and lumbar immobilization for follow-up.
FINAL COMMENTS:We would like to emphasize the importance of performing an abdominal CTto the diagnosis of spondylodiscitis caused by the psoas abscess. This condition presents with a complex and little-known diagnosis, related with several other pathologies and which, in our case, triggered a favorable outcome.

Palavras Chave

spondylodiscitis - psoas abscess