A missed psoas abscess diagnosis: A forensic case report

Area of Science:

• Forensic pathology
• Infectious diseases
• Nephrology

Background:

• Psoas abscess is a rare condition with non-specific symptoms, often delaying diagnosis and leading to severe complications.
• Risk factors include alcoholism, smoking, hypertension, and urinary tract infections.
• Early diagnosis and intervention are crucial for patient outcomes.

Observation:

• A 65-year-old male with multiple comorbidities presented with anorexia and altered consciousness.
• Physical examination revealed fever and confusion; laboratory tests showed leukocytosis and elevated C-reactive protein.
• Despite resuscitation, the patient died, with autopsy revealing a large left psoas abscess extending to the thigh and left kidney.

Findings:

• Autopsy identified extensive pus in the left psoas muscle and thigh, with destructive lesions in the left kidney.
• Histopathology confirmed chronic and acute pyelonephritis with dilated pyelocaliceal cavities.
• Bacteriological analysis isolated Escherichia coli from the abscess, indicating a secondary infection.

Implications:

• This case underscores the potential severity of psoas abscess, particularly when secondary to pyonephrosis.
• Septic shock resulting from a complicated psoas abscess can be rapidly fatal, even with medical intervention.
• Highlights the importance of considering rare diagnoses in patients with non-specific symptoms and risk factors.