Abstract
Psoas abscess is a rare pathology that usually presents with non-specific signs and rare clinical features. These characteristics can delay the diagnosis leading to complications and death. We report a forensic autopsy case of a 65-year-old male, alcoholic, smoker, with a history of hypertension, and urinary infection, who presented to the emergency room for anorexia and consciousness disorder. On physical examination, the patient was febrile and confused. Laboratory exams revealed leukocytosis and elevated C-reactive protein (CRP). Two days later, he died despite extensive resuscitation. Forensic autopsy revealed a large amount of green pus in the left psoas muscle extending to the muscles of the thigh of the same side with multiple cavities. The pus extended to the left kidney with destructive parenchyma and coralliform lithiasis. Histological examination showed destroyed renal tissue by lesions of chronic and acute pyelonephritis with dilatation of the pyelocaliceal cavities. Bacteriological analysis of the pus showed the presence of Escherichia coli. The psoas abscess was secondary to pyonephrosis favored by the immunodeficiency. Thus, death was attributed to a septic shock secondary to a psoas abscess complicating pyonephrosis.
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All authors contributed to the study conception and design. Conceptualization and supervision were performed by Nidhla Haj Salem. Material preparation, data collection, and analysis were performed by Meriem Grayaa, Sami Ben Jomaa, Said Saadi, Seif Ben Hammouda, Nouha Ben Abdeljelil, and Dorra Oualha. The first draft of the manuscript was written by Meriem Grayaa, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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All procedures performed in this study (involving human) were in accordance with the ethical standards of the “Research Ethics Committee, Faculty of Medicine, University of Monastir, Tunisia” and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This research was approved by the above-mentioned committee.
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Informed and written consent for publication was obtained from the family of the deceased subject. There were no identifying images published in this study.
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Grayaa, M., Ben Jomaa, S., Saadi, S. et al. A missed psoas abscess diagnosis: A forensic case report. Forensic Sci Med Pathol 18, 240–243 (2022). https://doi.org/10.1007/s12024-022-00464-7
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DOI: https://doi.org/10.1007/s12024-022-00464-7