A 70-year-old woman presented with a constitutional syndrome lasting 2 months with pain in the lumbar region and a limp. Physical examination revealed temperature of 38 C and pain on flexing the left hip but no other abnormal findings. Blood analysis showed: haemoglobin 11 gr/dl, 13800 leucocytes/mm3 (75% neutrophils), 380000 platelets/mm3; erythrocyte sedimentation rate 109 mm/hour, fibrinogen 981 mg/dl, albumin 2.9 gr/dl and ferritin 559 ng/ml. Radiography of the abdomen showed blurring of the line of the left psoas. Abdominal CT scan revealed a mass of lower density in the left psoas.
Percutaneous drainage was placed in the above-mentioned area, and purulent material was extracted. Gram-positive cocci in chains were observed, while a Ziehl-Neelsen stain was negative. Subsequently, Streptococcus anginosus was isolated in pure culture, using the API 20S system. MIC to penicillin was 0.03 microgr/ml. Treatment with ceftriaxone was initiated and the drainage maintained for 1 week.
When a new CT scan conducted after two weeks of treatment showed persistence of the abscesses, surgical drainage was indicated. Forty-five days after admission, Lowenstein culture from the previous puncture yielded a positive result for Mycobacterium tuberculosis. Treatment with isoniazid, rifampicin and pyrazinamide was initiated, after which the patient's condition improved both clinically and radiologically.