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Psoas abscess in rheumatoid arthritis--an inperspicuous diagnosis
A H Isdale1, D F Foley-Nolan, W P Butt
1Rheumatology and Rehabilitation Research Unit, Leeds.
Abstract:
Primary or secondary psoas abscess is infrequently seen but should not be forgotten. We report on two patients with RA who presented predominantly with back pain and who subsequently developed pyrexia. The correct diagnosis of psoas abscess was not immediately apparent. These cases and the discussion and comments which follow illustrate the difficulties that may be encountered and remind readers of this inperspicuous diagnosis.
Insights
Psoas abscess, a rare condition, can present subtly with back pain and fever, especially in rheumatoid arthritis (RA) patients. Early recognition is crucial for timely treatment of this challenging diagnosis.
Area of Science:
- Rheumatology
- Infectious Diseases
- Diagnostic Imaging
Background:
- Psoas abscess is an uncommon condition, often overlooked in clinical practice.
- Rheumatoid arthritis (RA) patients may present with atypical symptoms, complicating diagnosis.
- Back pain and pyrexia are key presenting symptoms that warrant further investigation.
Observation:
- Two rheumatoid arthritis (RA) patients presented with predominant back pain and subsequent pyrexia.
- The diagnosis of psoas abscess was not immediately evident in these cases.
- The clinical presentation highlighted diagnostic challenges associated with psoas abscess.
Findings:
- Psoas abscess can manifest insidiously, particularly in patients with underlying inflammatory conditions like RA.
- Delayed diagnosis can occur due to non-specific symptoms such as back pain.
- Pyrexia in RA patients can indicate serious underlying infections like psoas abscess.
Implications:
- Clinicians should maintain a high index of suspicion for psoas abscess in RA patients with back pain and fever.
- Prompt diagnostic workup, potentially including imaging, is essential for accurate and timely diagnosis.
- Awareness of this infrequent but serious condition can improve patient outcomes.