Phlegmonous Psoas Muscle Infection Causing Sepsis and Death With Missing Postmortem Computed Tomography Scan...

Area of Science:

• Medical Pathology
• Infectious Diseases
• Radiology

Background:

• Psoas muscle infections are rare but life-threatening, often presenting with back pain and fever.
• Abscess formation is typically identified via CT or MRI, but non-abscess infections like phlegmon can be challenging to diagnose.
• Early diagnosis is crucial to prevent sepsis and mortality.

Observation:

• A case of Staphylococcus aureus phlegmonous psoas muscle infection leading to sepsis and death is presented.
• The infection lacked typical abscess findings and was not identified on postmortem CT.
• Clinical presentation of back pain and an unidentified sepsis source prompted psoas muscle dissection.

Findings:

• Phlegmonous psoas muscle infection can cause severe sepsis and death without clear radiological signs of abscess.
• Computed tomography (CT) may miss non-abscess psoas infections, representing a potential diagnostic blind spot.
• Clinical suspicion is paramount when a septic focus remains unidentified.

Implications:

• This case underscores the importance of considering psoas muscle infection in patients with unexplained sepsis and back pain.
• Routine psoas muscle dissection should be considered in postmortem examinations when sepsis is suspected but the source is unclear.
• Improved diagnostic strategies for non-abscess psoas infections are needed to enhance patient outcomes.