Bilateral tuberculous psoas abscesses in an immunocompetent patient: a case report and review of the literature.

Abstract

Psoas abscess is a rare infection historically associated with tuberculosis (TB), although non-tuberculous bacterial causes, particularly Staphylococcus aureus, have become increasingly common. This type of abscess can be either primary or secondary, and its diagnosis remains challenging due to the non-specific nature of clinical signs. Imaging and microbiological analyses are essential for establishing the diagnosis. We report the case of a 22-year-old patient with no significant medical history, who presented with persistent mechanical low back pain for 18 months. Initial computed tomography revealed a non-compressive disc protrusion, leading to treatment with non-steroidal anti-inflammatory drugs, without improvement. Further investigations revealed an extrapulmonary spinal localization of TB in an immunocompetent patient, with bilateral psoas abscesses caused by Mycobacterium tuberculosis, confirmed by the Ziehl-Neelsen staining, auramine staining, culture on Löwenstein-Jensen medium and GeneXpert PCR. Anti-TB treatment was initiated, resulting in favourable clinical evolution.