SHM Converge Scientific Abstract ePoster Gallery-A Case of Iliopsoas Abscess Secondary to an Undiagnosed Ruptured Appendix

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This case report describes a 15-year-old previously healthy male who developed an iliopsoas abscess caused by an undiagnosed ruptured appendix. He presented with two weeks of fever and a painless right-sided limp, along with right anterior thigh pain, but no hip pain, trauma, neurologic symptoms, or weakness. He remained active and continued playing soccer. Because his symptoms were nonspecific, he was evaluated three times at an outside hospital and was initially diagnosed with tendonitis.<br /><br />During evaluation, he was febrile to 39.3°C and had leukocytosis with elevated inflammatory markers. Examination showed painless full range of motion of the right leg, ability to bear weight, intermittent antalgic gait, and mild right lower quadrant abdominal tenderness. Hip x-rays were reassuring, and abdominal ultrasound showed a borderline enlarged, fluid-filled appendix concerning for appendicitis. MRI later identified a 2.8 x 1.9 cm abscess anterior to the right iliopsoas muscle.<br /><br />The abscess could not be drained because of its location, so he was treated medically with IV piperacillin-tazobactam (Zosyn), with improvement in inflammatory markers and white blood cell count. He was discharged on oral ciprofloxacin and linezolid, with plans for interval appendectomy two weeks later.<br /><br />The report emphasizes that iliopsoas abscess is rare and often difficult to diagnose because symptoms can be vague, such as fever, limp, thigh pain, or pain radiating to the hip or pelvis. Iliopsoas abscesses may be primary or secondary; in this patient, the source was secondary spread from a ruptured appendix. Clinicians should consider this diagnosis in patients with prolonged fever and gait abnormalities, and if an iliopsoas abscess is found, secondary causes should be investigated to guide treatment.

Asset Subtitle

Hala Ali Ibrahim

Meta Tag

Author List Hala Ali Ibrahim, Sarah F. Denniston, Tuhina Joseph

Category Clinical Vignettes

Concept Iliopsoas Abscess

Concept Perforated Appendicitis

Concept Fever

Concept Limp

Concept Thigh Pain

Distinguished Non-Finalist

Presenter Organization Tufts Children's Hospital

Presenting Author Hala Ali Ibrahim

Track Pediatric

Keywords

iliopsoas abscess

ruptured appendix

appendicitis

fever

limp

adolescent

right thigh pain

MRI diagnosis

secondary infection

piperacillin-tazobactam

Iliopsoas Abscess

Perforated Appendicitis

Fever

Limp

Thigh Pain