A case of tuberculous
psoas abscess complicated during antituberculosis
therapy for
miliary tuberculosis and successfully treated with surgery was reported. A 20-year-old man visited our hospital because of
fever lasting for 3 months. Chest radiography showed miliary nodules in both lungs and transbronchial lung biopsy revealed
granuloma. Magnetic resonance imaging of the head showed small lesions in the brain. Computed tomography of the abdomen showed an enlarged paraaortic lymph node and a nodule in the spleen. Needle biopsy of the lymph node revealed necrotic tissue. Mycobacterium tuberculosis was not isolated; however,
miliary tuberculosis was highly suspected based on clinical and radiographic findings. Once antituberculosis
therapy was initiated with
isoniazid,
rifampicin,
streptomycin, and
pyrazinamide, the
fever subsided. In spite of improvement of general radiographic findings, a new
abscess was found in the right psoas major muscle after 8 months of
therapy by computed tomography. A sample of the
abscess showed a positive smear, negative culture, and positive PCR test for M.
tuberculosis. Although antituberculosis
therapy continued for another 6 months, the
abscess enlarged to 7 cm and new retroperitoneal lymph nodes also appeared. Surgical drainage and
curettage of the
abscess was performed. Intra- and post-operative specimens were negative for bacteria, fungi, and M.
tuberculosis. The patient was treated with
isoniazid,
rifampicin, and
ethambutol for one year postoperatively. The disease disappeared without any evidence of relapse for 2.5 years after surgery.