A late diagnosis of Pott's disease in an adolescent with psoas abscess

Abstract

Psoas abscess is classified as primary or secondary according to presence or absence of the underlying focus of infection. Secondary psoas abscesses are much more common and tuberculosis of the spine (Pott's disease) is one of the leading predisposing diseases. Here we report a 16-year-old male presented with flank pain and abdominal distention, followed by spontaneous purulent drainage from lower back and lower abdomen. Eventually a painful swelling appeared below the right knee about one year after the appearance of the first symptoms. He was diagnosed as Pott's disease and secondary psoas abscess based on specific culture of draining pus, which yielded Mycobacterium tuberculosis and spinal magnetic resonance imaging (MRI) findings. Psoas abscess due to Pott's disease may show a nonspecific and chronic clinical course resulting in a late diagnosis and increased morbidity, as in the reported case. Clinicians in the endemic countries should be aware of this rare and challenging clinical entity.