Primary Tubercular Psoas Abscess: An Unusual Cause of Groin Pain

Abstract

Psoas abscess, a collection of pus in the iliopsoas compartment is an unusual lesion that is unfamiliar to many medicine specialists, which can make an accurate and timely diagnosis problematic. The symptoms associated with this disorder often involve hip pain instead of abdominal or back pain. For this reason, the diagnosis of psoas abscess in patients who present with groin pain may be delayed because such pain is atypical for this condition. Tuberculous abscesses in the iliopsoas muscle are usually secondary to pott´s disease or spinal tuberculosis. Another possibility is direct extension from nearby structures or hematogenous spread from a distant focus. Here we report a rare case of a 24-year-old immunocompetent lady who presented with right groin pain and limping and subsequently was diagnosed with psoas abscess with no other apparent focus. Diagnosis is done based on history, physical examination, plain radiology, microbiological investigation and CT scan of abdomen which revealed a large psoas abscess caused by M. tuberculosis. She was treated with DOTS category I along with surgical drainage of the abscess and significant functional improvement was noted on follow up. The objective of this article is to keep in mind the possibility of primary tuberculosis in the form of an abscess in the psoas in order to help in its complex diagnostic approach, as well as review the most adequate diagnostic and therapeutic methods.