Latent solitary tuberculous psoas abscess 52 years after healed thoracolumbar tuberculous spondylitis.

Abstract

This study reports on an extremely rare case of tuberculous psoas abscess and describes the mode of diagnosis and treatment. This patient is presented to emphasize that cases of solitary psoas abscess resulting from tuberculosis exist today. No recent cases of latent solitary tuberculous psoas abscess have been reported, to the authors' knowledge. A tuberculous psoas abscess associated with fistula to the greater trochanter may remain dormant for years after tuberculous spondylitis has healed, as a distinct entity without concomitant active bone infection. In our 58-year-old female patient, the diagnosis of a psoas abscess was greatly aided by the "three pass" technetium bone scan and computed tomography, but the anamnesis also was important. Anti-tuberculosis medication (streptomycin, aminosalicylic, and isoniazid) combined with open drainage, curettage of the psoas, and simultaneous revision of the fistula eradicated the disease, making the course of the disease uneventful until the 5-year follow-up evaluation. Orthopedic surgeons must be aware of the rare, delayed appearance of a solitary psoas abscess after tuberculous spondylitis.