Bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient: a case report

Worldwide, there is an increase in the frequency of reports of psoas abscesses due to advances in imaging technology, which has led to early diagnosis and treatment. A bilateral psoas abscess is rare and, when it occurs, is usually secondary and in immunocompromised patients. We present a case of a bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient.

A 21-year-old Ugandan female undergraduate who contracted human immunodeficiency virus through vertical transmission and has been on highly active antiretroviral drugs presented with bilateral lower abdominal pain with associated fever and headache. Clinical examination revealed abdominal tenderness in both iliac fossae with palpable masses. Ultrasonography revealed fluid collection in both psoas muscles confirming bilateral abscesses. The aspirate was acid-fast bacilli positive. A diagnosis of bilateral tuberculosis psoas abscess was made. Open drainage was performed and antituberculosis drugs were commenced.

Bilateral tuberculosis psoas abscesses occurring in human immunodeficiency virus-positive patients, although uncommon, is not unexpected. It is a form of secondary psoas abscess in immunocompromised patients. Here, the outcome was successful with a combination of early surgical drainage and appropriate medical therapy.