A large iliopsoas abscess due to migration of ureteral stent: a case report

Iliopsoas abscess (IPA) is a rare but potentially life-threatening condition. Due to its nonspecific clinical presentation and low incidence, IPA often leads to diagnostic delays and suboptimal initial management. Secondary IPA originating from urinary tract complications is extremely rare, and IPA induced by ureteral stent migration appears to be exceptionally uncommon. Fungal IPA caused by Candida tropicalis is also a scarcely reported clinical entity, especially in immunocompromised patients with long-term rheumatoid arthritis (RA).

We report a 63-year-old woman with a history of rheumatoid arthritis (RA) and prior colon cancer surgery that involved partial ureteral resection and ureteral stent implantation 6 months ago. The patient later developed IPA, which was successfully managed with dual ultrasound-guided percutaneous drainage, ureteral stent exchange, and systemic antimicrobial therapy. Cultures of the drained abscess and urine both yielded C. tropicalis; the drainage-fluid creatinine (5,334 μmol/L) was consistent with urine, suggesting that the IPA likely originated from infected urine leaking from the ureteral anastomosis due to migration of the ureteral stent. The patient was eventually discharged without further complications.

Ultrasound-guided percutaneous drainage is a safe and effective treatment modality for IPA. This case highlights that ureteral stent migration, though typically managed uneventfully, may precipitate severe septic sequelae including IPA, particularly in immunocompromised patients.