Psoas abscess and severe fasciitis due to a caecal carcinoma

A man in his mid-50s presented with a painful and swollen right thigh and buttock. This was accompanied by a month long history of flank pain, back pain, vague abdominal pain, limp, fever and weight loss. On examination, there was extensive erythaema, heat, tenderness, oedema and crepitus over his right buttock and thigh. The patient was referred to plastic surgery to exclude necrotising fasciitis of the gluteal and thigh region. After CT imaging, a psoas abscess (PA) and caecal mass were identified. Subsequent right hemicolectomy, PA drainage and debridement of his right thigh were performed. This case reminds clinicians of the many non-specific ways a PA can present and that a high level of suspicion assists in making a timely diagnosis.