A case of bilateral psoas abscess following prostate biopsy
Varga Dániel dr., Murányi Mihály dr., Flaskó Tibor dr.
Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Tanszék, Debrecen (igazgató: Flaskó Tibor dr.)
Introduction: According to the scientific literature, formation of a psoas abscess following prostate biopsy is extremely rare. Furthermore, there has not been any report yet on a case of a two-sided abscess invading the paralumbal muscles requiring surgical intervention. In this paper, we present the successful treatment of a bilateral psoas abscess that developed after transrectal prostate biopsy performed under antibiotic protection.
Case report: A 62-year-old man reported to our clinic with urosepsis 8 days after prostate biopsy. Despite targeted antibiotic therapy, the patient’s septic status did not improve and paraparesis developed. An MRI scan showed abscesses in both psoas major and the right paralumbal muscles, furthermore an epidural phlegmon. Because of the latter, evacuation of the epidural abscess was performed at our neurosurgical institute. Repeated MRI showed further increase in the size of abscesses, thus the abscesses were opened and drained in our clinic. Targeted antibiotic treatment was performed. Control MRI described the regression of the inflammatory process. Subsequently, laparoscopic radical prostatectomy was performed at our institute. Based on the most recent control examination in February 2019, the patient is free of complaints.
Conclusions: Our case study draws attention to the fact that even after the simplest intervention performed according to the protocol, a serious life-threatening condition may develop, as well as that the increase in fluoroquinolone-resistant strains is diminishing the effectiveness of these antibiotics. If the imaging method does not clearly state the cause of the inflammation, it is necessary to repeat the test or to perform additional imaging studies, especially if the inflammatory parameters do not improve despite the targeted antibiotic therapy.