Pott hastalığı sonrası psoas absesi gelişen bir adolesan olgu

Abstract

Psoas abseleri altta yatan enfeksiyon odağının olup olmamasına göre primer ve sekonder olarak sınıflandırılmaktadır. Sekonder psoas abseleri daha sık görülür. Pott hastalığı olarak da bilinen vertebra tüberkülozu psoas abselerinin önde gelen nedenlerinden biridir. Bu yazıda, ilk olarak böğür ağrısı ve karında şişlik yakınmaları gelişen 16 yaşındaki bir erkek hasta tanıtılmaktadır. Bu yakınmaları takiben sırt ve karın bölgesinde kendiliğinden akıntı gelişmiş ve nihayetinde ilk yakınmalardan yaklaşık 1 yıl sonra sağ diz altı bölgesinde ağrı ve şişlik oluşmuştur. Hastaya, akıntının spesifik kültüründe Mycobacterium tuberculosis üremesi ve spinal MRI bulguları ile Pott hastalığına sekonder psoas absesi tanısı konulmuştur. Pott hastalığına sekonder gelişen psoas abselerinde kronik ve belirsiz klinik süreçler görülebilir. Bu durum ise, hastamızda olduğu gibi tanıda gecikmeyle sonuçlanabilir. Özellikle tüberkülozun endemik olduğu ülkelerde klinisyenlerin bu nadir ve tanısı karışıklık yaratabilen hastalığı akılda tutmaları gerekmektedir.

Keywords

• Psoas absesi, Pott hastalığı, tüberküloz, Ayırıcı tanı

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

Keywords

• Psoas abscess,Pott’s disease,tuberculosis,Differential diagnosis

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