International Journal of STD & AIDS 1992; 3: 294
CASE REPORT
Staphylococcus aureus psoas abscess in a patient with AIDS M R Nelson MBBS MRCP, D Daniels MBBS MRCP, R Dean S Barton MD MRCOG, and B G Gazzard MD FRCP
MBBS,
Department of HIV/Genitourinary Medicine, The Kobler Unit, St Stephen's Clinic, London, UK Keywords: Staphylococcus aureus, psoas abscess, AIDS
Individuals infected with the human immunodeficiency virus (HIV) have an increased susceptibility to bacterial infectionsl>'. Psoas abscesses secondary to both Salmonella Spp.4,5 and tuberculosiss? have been reported in patients with HIV. We report a case of a psoas abscess due to Staphylococcus aureus.
CASE REPORT
A 33-year-old homosexual male presented with intermittent right upper quadrant pain, nausea and diarrhoea of 6 weeks' duration. There were no urinary symptoms. He had been known to be HIV seropositive for 5 years with a previous AIDS diagnosis of cytomegalovirus (CMV) oesophagitis. On examination he was pyrexial (38.5°C), but apart from 3 em hepatomegaly, clinical examination was unremarkable. He was HIV antigen positive (460 pg/ml) and his CD4 count was markedly low (20/mm 3 ) . Total white count blood cell count and haemoglobin were normal. Plain abdominal radiology, sigmoidoscopy and oesophagoduodenoscopy were normal. Three sets of blood cultures were negative after 7 days' incubation. Endoscopic retrograde choledocopancreatography showed evidence of sclerosing cholangitis and he was treated with intravenous foscarnet for 3 weeks because of the previous history of CMV disease. However there was no resolution of his symptoms and the patient was further investigated with computerized tomography (CT) of the abdomen and pelvis. CT scan showed a right-sided psoas abscess (see Figure 1). The abscess was aspirated and 40 ml of pus recovered. Microscopy demonstrated Gram-positive cocci and Staphylococcus aureus was grown from the aspirate. The patient was treated with flucloxacillin and Fucidin, and 6 weeks later repeat CT scanning showed resolution of the abscess with fibrosis. DISCUSSION Although psoas abscesses due to other organisms Correspondence to: Dr BG Gazzard, HIV/GUM Dept, The Kobler Unit, St Stephen's Clinic, 368 Fulham Road, London SW10, UK
Figure 1. CT scan showing a right-sided psoas abscess
have previously been described in 'HIV antibody positive patients, we believe this is the first case report of Staphylococcus aureus causing this condition. It is important that all psoas abscesses should be aspirated at the earliest opportunity so that appropriate antibiotic therapy can be initiated. References 1 Simberkoff MS, El-Sadr W, Schiffman G, Rakal JJ Jr. Streptococcus pneumoniae infections and baeteraemia in patients with acquired immune deficiency syndrome, with report of a pneumococcal vaccine failure. Ann Rev RespirDis 1984;130:1174-6 2 Schwann HT, [anowitiz SR. Haemophilis influenzae pneumonia in young adults with AIDS, ARC or at risk of AIDS. Am J Med 1989;86:11-14 3 Celum CL, Chaisson RE, Rutherford GW, et al. Incidence of salmonellosis in patients with AIDS J Infect Dis 1987; 156:998-1002 4 Zumla A, Luo NP. Surgery and salmonella. 8MJ 1990;300:1342 5 Perera L, Luo N, Zurnla A. Bacteraemias in HIV positive patients Lancet 1990;336:877-8 6 Brisson NA, Gicquel B, Lecossier 0, Levy V, Nassif X, Hance A. Rapid diagnosis of tuberculosis by amplification of mycobacterial DNA in clinical samples. Lancet 1989;ii:1069-71 7 Rosengart TK, Coppa G. Abdominal mycobacterial infections in immunocompromised patients. Am J Surg 1990;159:125-31
(Accepted 14 January 1992)
CASE REPORT
Staphylococcus aureus psoas abscess in a patient with AIDS M R Nelson MBBS MRCP, D Daniels MBBS MRCP, R Dean S Barton MD MRCOG, and B G Gazzard MD FRCP
MBBS,
Department of HIV/Genitourinary Medicine, The Kobler Unit, St Stephen's Clinic, London, UK Keywords: Staphylococcus aureus, psoas abscess, AIDS
Individuals infected with the human immunodeficiency virus (HIV) have an increased susceptibility to bacterial infectionsl>'. Psoas abscesses secondary to both Salmonella Spp.4,5 and tuberculosiss? have been reported in patients with HIV. We report a case of a psoas abscess due to Staphylococcus aureus.
CASE REPORT
A 33-year-old homosexual male presented with intermittent right upper quadrant pain, nausea and diarrhoea of 6 weeks' duration. There were no urinary symptoms. He had been known to be HIV seropositive for 5 years with a previous AIDS diagnosis of cytomegalovirus (CMV) oesophagitis. On examination he was pyrexial (38.5°C), but apart from 3 em hepatomegaly, clinical examination was unremarkable. He was HIV antigen positive (460 pg/ml) and his CD4 count was markedly low (20/mm 3 ) . Total white count blood cell count and haemoglobin were normal. Plain abdominal radiology, sigmoidoscopy and oesophagoduodenoscopy were normal. Three sets of blood cultures were negative after 7 days' incubation. Endoscopic retrograde choledocopancreatography showed evidence of sclerosing cholangitis and he was treated with intravenous foscarnet for 3 weeks because of the previous history of CMV disease. However there was no resolution of his symptoms and the patient was further investigated with computerized tomography (CT) of the abdomen and pelvis. CT scan showed a right-sided psoas abscess (see Figure 1). The abscess was aspirated and 40 ml of pus recovered. Microscopy demonstrated Gram-positive cocci and Staphylococcus aureus was grown from the aspirate. The patient was treated with flucloxacillin and Fucidin, and 6 weeks later repeat CT scanning showed resolution of the abscess with fibrosis. DISCUSSION Although psoas abscesses due to other organisms Correspondence to: Dr BG Gazzard, HIV/GUM Dept, The Kobler Unit, St Stephen's Clinic, 368 Fulham Road, London SW10, UK
Figure 1. CT scan showing a right-sided psoas abscess
have previously been described in 'HIV antibody positive patients, we believe this is the first case report of Staphylococcus aureus causing this condition. It is important that all psoas abscesses should be aspirated at the earliest opportunity so that appropriate antibiotic therapy can be initiated. References 1 Simberkoff MS, El-Sadr W, Schiffman G, Rakal JJ Jr. Streptococcus pneumoniae infections and baeteraemia in patients with acquired immune deficiency syndrome, with report of a pneumococcal vaccine failure. Ann Rev RespirDis 1984;130:1174-6 2 Schwann HT, [anowitiz SR. Haemophilis influenzae pneumonia in young adults with AIDS, ARC or at risk of AIDS. Am J Med 1989;86:11-14 3 Celum CL, Chaisson RE, Rutherford GW, et al. Incidence of salmonellosis in patients with AIDS J Infect Dis 1987; 156:998-1002 4 Zumla A, Luo NP. Surgery and salmonella. 8MJ 1990;300:1342 5 Perera L, Luo N, Zurnla A. Bacteraemias in HIV positive patients Lancet 1990;336:877-8 6 Brisson NA, Gicquel B, Lecossier 0, Levy V, Nassif X, Hance A. Rapid diagnosis of tuberculosis by amplification of mycobacterial DNA in clinical samples. Lancet 1989;ii:1069-71 7 Rosengart TK, Coppa G. Abdominal mycobacterial infections in immunocompromised patients. Am J Surg 1990;159:125-31
(Accepted 14 January 1992)
