Septic shock secondary to a giant primary iliopsoas abscess: a case report

Primary iliopsoas abscess (PIPA) is a rare clinical condition, typically of hematogenous origin, with an unclear etiology. Despite its low incidence, delayed diagnosis and treatment can lead to a high mortality rate. This case report underscores the necessity of early identification and standardized management of PIPA to mitigate the risk of death.

This case study presents a 48-year-old male with a large PIPA, complicated by poorly managed diabetes mellitus, initially misdiagnosed with lumbar disc herniation and sciatica. The disease progression caused septic shock, revealing a substantial abscess (25.1 × 14.6 × 11.3 cm) in the left iliopsoas compartment on contrast-enhanced CT. Following shock resuscitation, the patient underwent open surgical drainage and received targeted antimicrobial therapy, resulting in significant clinical improvement.

PIPA presents nonspecific early clinical manifestations, posing diagnostic challenges. Timely and accurate diagnosis is crucial to prevent severe complications, especially in immunocompromised patients at higher risk. Computed tomography and magnetic resonance imaging are vital for confirming iliopsoas abscess presence. Standard treatment includes antimicrobial therapy combined with surgical or image-guided drainage.

Enhancing early diagnostic accuracy of PIPA is imperative to enhance patient outcomes and reduce mortality rates.