[Tuberculous psoas abscess in a patient with HIV]

Psoas abscess is an uncommon disease with varied etiology. The most common pathogen in primary abscess is Staphylococcus aureus. Crohn's disease is the most common cause of a secondary abscess. Recently, drug abuse and HIV infection have become important risk factors in identification of a patient with psoas abscess. Mycobacterium tuberculosis is considered an extremely rare cause of psoas abscess, but it is reported in HIV patients. Physical presentation is insidious; classical symptoms are pain and fever. Computed tomography (CT) is the most important tool for diagnosis. Preferred treatment is percutaneous drainage guided by CT. Open surgical drainage should be reserved if percutaneous drainage fails, if possible by extraperitoneal approach; in secondary abscess, the transperitoneal approach is preferred to correct the possible disease.