SHM Converge Scientific Abstract ePoster Gallery-Iliopsoas Abscess Following Spinal Injection in Patient With Uncontrolled Diabetes

Pdf Summary

This case report describes a 49-year-old man with poorly controlled type 2 diabetes who developed a large left iliopsoas abscess after receiving multiple epidural steroid injections at a chiropractic clinic in Mexico. He presented to the emergency department with generalized weakness, severe low back and left flank pain, melena, and coffee-ground emesis after heavy naproxen use. Examination showed tachycardia and marked flank tenderness, while labs revealed significant leukocytosis and severe hyperglycemia (glucose 576 mg/dL; HbA1c 11.6%).<br /><br />Contrast-enhanced CT of the abdomen and pelvis identified a 9 × 10 × 4 cm complex retroperitoneal mass involving the left iliopsoas muscle, consistent with an abscess, along with bony erosion of the L1 endplate. He was treated immediately with broad-spectrum intravenous antibiotics and underwent image-guided percutaneous drainage. His condition improved rapidly, with reduction in abscess size and normalization of the white blood cell count. Drain cultures later grew Streptococcus constellatus, allowing antibiotic narrowing to ceftriaxone plus metronidazole for a total six-week course.<br /><br />The report emphasizes that although spinal injections are generally safe, infections can occur, and severe infectious complications are rare but serious. Poorly controlled diabetes likely increased this patient’s vulnerability by impairing immune function. The authors conclude that clinicians should consider deep infectious complications, including psoas abscess, in patients with back pain after epidural steroid injections—especially when additional risk factors such as uncontrolled diabetes are present.

Asset Subtitle

Eunbee Cho

Meta Tag

Author List Celin Rajan, Eunbee Cho, Jian Cruz, Seokwon Choi, Vamsikalayan Borra

Category Clinical Vignettes

Concept Iliopsoas Abscess

Concept Type 2 Diabetes Mellitus

Concept Image-Guided Drainage

Concept Intravenous Antibiotics

Concept Infection Susceptibility

Distinguished Non-Finalist

Presenter Organization UTRGV Knapp Medical Center

Presenting Author Eunbee Cho

Track Adult

Keywords

psoas abscess

iliopsoas abscess

epidural steroid injection

poorly controlled diabetes

Streptococcus constellatus

retroperitoneal abscess

back pain

image-guided drainage

intravenous antibiotics

spinal injection infection

Iliopsoas Abscess

Type 2 Diabetes Mellitus

Image-Guided Drainage

Intravenous Antibiotics

Infection Susceptibility