[Psoas abscess after ureteral stent exchange for cutaneous ureterostomy: report of a case]

A 69-year-old man underwent a radical cystectomy and cutaneous ureterostomy for carcinoma in situ of the urinary bladder. The ureteral stents were exchanged for cutaneous ureterostomy 35 days after the operation. The patient suffered from high fever with chills a few hours after the stent exchange, and was readmitted to our hospital. High fever was not improved by treatment with Ceftriaxone for 5 days. Five days after the stent exchange, computed tomography (CT) revealed a right psoas abscess. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the blood culture. Urine culture showed MRSA, Pseudomonas aeruginosa and Enterococcus faecium. Computed tomography-guided percutaneous catheter drainage and treatment consisting of vancomycin, minocycline and ciprofloxacin were performed for the psoas abscess. This treatment significantly reduced the size of the abscess and high fever was improved. The catheter was removed 22 days after the drainage. However, magnetic resonance imaging revealed a spondylitis at L4 and L5. Therefore, antibiotics treatment was continued for about 3 months. There has been no sign of recurrence of bladder cancer and psoas abscess at 23 months after the operation.