A gigantic iliopsoas abscess in a patient with Alexander's disease

This case highlights the importance of early diagnosis of iliopsoas abscess in patients with communication difficulties and appropriate treatment to prevent further complications.

We report a case in which the detection of an iliopsoas abscess was delayed due to difficulty in communication but was successfully treated with percutaneous drainage. A 70-year-old man with a 38-39°C fever and 5.69 mg/dL C-reactive protein. Adult-onset Alexander's illness, affected his swallowing, speech, coordination, and motor function. Abdominal computed tomography revealed a big iliopsoas abscess. Antibacterial treatment followed percutaneous draining. Drainage reduced temperature and inflammation. Four months later, the iliopsoas abscess returned, the second drainage eliminated recurrence. Difficulty in communicating was a contributing factor to the delayed diagnosis of a giant iliopsoas abscess. In the treatment of such patients, percutaneous drainage seems effective as an initial therapy.