Psoas Abscess out of the blue

[Aerv]

Hi everyone and thank you for making this forum so active,

My aim for this post is to present myself and the last 6 months of my life that have involved illness in the form of a tenacious psoas abscess. Partially it's just written as self processing. Till this day I don't know how or why this could happen. If you have any comments or relevant experiences I'm all ears

February 2013. Winter holiday, outback skiing in the beautiful mountains of Norway. I'm a 28 year-old happy idiot high on life on my 2nd year of my PhD in molecular biology, with no idea of what's looming ahead. One afternoon during these days of skiing my right hip suddenly turns painful and I'm unable to retract my right foot. It feels like a lower spine disc is a bit out of place and just needs to fall back into place for it all to clear up and restore flexibility. But the problem persists and worsens. The pain originates from a tiny "spot" within my lower back. After the car drive home, I literally fall out of the driver seat and this immense cramping of my right leg grabs hold. I pay my general practitioner a visit, but no visible signs of injury are apparent and I declare I have not experienced any kind of trauma to the area. He sends me home with a perscription for voltaren painkillers. Weeks go by and the pain remains constant.

Springtime. Something is swelling and causing significant pain in my right hip. Weeks go by before I get through to my GP, hoping the problem would dissappear by itself by then. Starting from normal weight I quickly lost 8kg along with any appetite for food. Consistently experiencing night sweats. I finally get appointment and the Doc looks at me and decides we need a CT. Weeks pass and I finally get my imaging done. The day after my GP calls me in and admits me directly to the local hospital ER. Following a superficial check-up I'm transferred to the department of oncology, suspecting sarcoma and/or lymphoma. At this point I'm just so glad to be in good hands and not the slightest bit worried about cancer, I have no family history with that. My serum CRP is stable at 250mg/L and the pain is unbearable. We tried a week of morphine-like pills to take the edge of it but it was a horrible experience, being like a zombie, and I decided I was better off without it.

Summer. MRI, CT, PET, repeat. Turns out we are dealing with a bacterial abscess. Extremely compact and gelatinous pus from the abscess cavity reveals growth of "Enterococcus avium" - a bacteria associated with birds' digestive system, along with other bacteria of the gut flora. A quick search on PubMed reveals some 8 case reports of infections with the Avium bacterium in the history of medicine, of which all subjects eventually died. Puzzling (all pun intended) to say it the least. Resistance profiling of the bacteria indicates I get started on ampicillin i.v. One week later my entire body is red, turns out I'm allergic. Next try: vancomycin. With vanco I experience an unprecedented side effect involving all my skin comes off in flakes. It's not "red-man syndrome" or histamine related nor is it the dreaded Stevens-Johnson syndrome. We agree to continue vancomycin and gradually my CRP and overalll condition improves. Finally I get a drain inserted, upon insertion it drains away 1L really viscous pus. We make arrangements with the doctors so that my girlfriend who is a nurse -thank God for nurse girlfriends- can administer my vancomycin at home. She's my personal angel, mother Theresa and Elvis <3

2 months pass and I get started on ciprofloxacin and flagyl oral antibiotics as repeated ultrasound and CT imaging suggest the abscess just won't shrink in size. Doctors think it may be connected to my intestines through fistulas or be the result of diverticulitis, but ultimately fail to arrive at any conclusion. We finally discontinue vancomycin and my baby skin gets a rest. Two medical attempts to remove the drain and/or quitting antibiotics results in abscess returning with a vengeance just days after. Surgery is needed.

2 more months. Present day. Still wearing the drain, still eating oral antibiotics. Still no explanation as to how or why this abscess came to settle in my right hip. The latest conspiracy theory from the doctors involves some kind of subclinical appendicitis; "We'll cut you open and take it from there". Crohn's disease is not yet diagnosed, and I hope it stays that way. Surgery's in three weeks.

When you're sick the really important things in life are highlighted. All I want for Christmas is a lime mojito and my health back
Thank you for reading

 

[DustyKat]

Hi Aerv and :welcome:

I'm sorry to hear of all you have been going through.

Have you ever had a sinogram done to see if there is a connection from the abscess to the intestine?
The fact that the abscess kept reforming would be why they are thinking there is a connection (fistula).

If you do have inflammation present in any of the structures adjacent to the psoas muscle then it certainly has the potential to create abscess. Appendicitis could do this as indeed could Crohn's. My son developed a psoas abscess from Crohn's located in his terminal ileum. The problem is inflammation causes tissue to swell, the inflamed and swollen tissue then presses against the surrounding structures like muscles and other organs. This constant contact then causes those structures to become inflamed and you can then develop complications like fistulas and/or abscesses.

My son was diagnosed with Crohn's very quickly so his initial symptoms were mild to say the least. However he was no sooner diagnosed before he developed the psoas abscess. Once it was identified he had a pigtail drain inserted and a few days later a sinogram confirmed the connecting fistula...they inject dye through the drain. Due the connection the drain stayed in until he had surgery to remove the diseased area of bowel.

If you have any questions please don't hesitate to ask. Good luck!

Dusty. xxx

 

[Aerv]

Thanks for your post, Dusty. Sorry to hear of your affected children, from all my heart I wish you all the best
I've not had a sinogram like you described, but at multiple occasions I have been drinking loads of contrast fluid followed by CT scans to check for passages between the GI tract and the abscess. No link was established, although I think we did this three times. Also did enema contrast (not awesome), colonoscopy and sigmoidoscopy with no pathological findings. But they never went past my appendix into the ileum/small intestines.

Yeah the pigtail drain... still wearing it. I wash it regularly with NaCl but it never stops being pyogenic. Doctors are reluctant to insert anything other than saline for sanitary purposes. I hope surgery will bring all this to an end. Frightening prospect that Crohn's may present as localized bowel pathology, as with your son.

My family has a thing with autoimmune diseases but so far in my life I've been ridiculously healthy, apart from an inguinal hernia (right side, same as abscess) in 2011. I tried to lift a boat engine, and well... I had abdominal surgery and got some kind of mesh inserted some weeks later. I was thinking maybe the current abscess could be a result of some post-operative latent infection or complication? Doctors were reluctant to comment on this, for all I know I should be filing a case versus that surgeon clinic I visited 2 years ago.

I'll post an update when surgery is concluded.

 

[Aerv]

So I had surgery done 2 days ago! Four hours spent on that table and today the lead surgeon came to see me. Turns out it was a complicated case of appendicitis: it was severely dislocated and had somehow ended up attached to my right psoas muscle, facilitating abscess formation in a locked-in lumen and nourishing it with bacteria. They had a hard time locating the appendix initially and ended up removing my terminal ileum and some 15cm downstream colon bowel in order to proceed. The abscess was cleared and cleaned out. They conclude that this erratic appendicitis accounts for all my troubles and discontinued antibiotic treatment effective immediately. No Crohn's or diverticulitis. I'm okay with that. Lots of air in my bowels and intense visceral pain these days. Today I managed to stand up, so that's a start

But, there is always this but. I was also told samples of my excised appendix had been sent to the lab for testing. The observed enlarged appendix rose their suspicion of something called "Mucocele appendix veriformis". This is apparently some kind of mucus-cell cancer derived from the appendix that can lead to a "pseudomyxoma peritonei", which sounds like a bad diagnosis just from its name already.
Sample testing will take two weeks. Here's to hoping it's benign...

I had appendicitis cured by antibiotics at the age of 2, so it's just bad luck my folks didn't insist on having it removed then. Screwed my entire year 2013, almost had me killed infact, and inevitably put a lot of burden on the healthcare system. This will be the take-home message to all parents reading this. Shocking to realize it can take 8 months to diagnose and appropriately treat advanced and potentially lethal appendicitis in the hands of a well-funded and supposedly competent western healthcare system. Bad luck, I guess :S

 

[Aerv]

Right on. Malignant adenocarcinoma of the appendix veriformis. See you on the flip side...

 

[Trysha]

Sorry to hear that Aerv-----
Hopefully they took out all the malignancy .
Feel better soon
Hugs and best wishes
Trysha