Sequential Development of Iliopsoas Hematoma and Abscess in an Elderly Patient With COVID-19: A Case Report

Iliopsoas hematoma and iliopsoas abscess are rare but serious conditions that may complicate the course of elderly patients with COVID-19. The infection itself, along with corticosteroids, anticoagulation, and other immunosuppressive therapies used in treatment, can increase susceptibility to both bleeding and secondary infections. Distinguishing between hematoma and abscess is particularly challenging in this setting, as their clinical presentations often overlap. Early recognition through repeated imaging and timely intervention is therefore essential. We report the case of an 82-year-old man with COVID-19 pneumonia initially treated with dexamethasone, remdesivir, and antibiotics. His respiratory status worsened, prompting transfer to our hospital, where additional immunosuppressive therapy and anticoagulation were administered. During hospitalization, he developed acute right lower abdominal pain, and imaging revealed an iliopsoas hematoma, for which conservative management was chosen. He was later re-admitted with recurrent respiratory failure and diagnosed with organizing pneumonia requiring steroids. Subsequently, his oral intake declined, and further evaluation demonstrated a retroperitoneal mass with intralesional gas. Aspiration confirmed purulent fluid, establishing the diagnosis of an iliopsoas abscess. Drainage and antimicrobial therapy were initiated, resulting in gradual clinical improvement. This case underscores the diagnostic challenge of differentiating hematoma from abscess in elderly patients after COVID-19 and highlights the importance of vigilant follow-up.