Iliopsoas Abscess in a 24-Months-Old Child: Management in Absence of an Identifiable Organism

Iliopsoas abscess presents with vague and variable symptoms and is less commonly encountered in a clinical setting. The most common causative agent is staphylococcus aureus. In our case, a 2-year-old boy presented with high-grade fever, difficulty in walking, and pain in the right leg near the hip joint. Psoas sign was positive but his blood cultures were negative and CT scan showed a necrotic mass with peripheral enhancement measuring 7.0x4.2x2.6 cm in all three dimensions in right Psoas muscle. Biopsy of the abscess was denied and the patient was managed conservatively with intravenous ceftriaxone and metronidazole. This case highlights the importance of clinical examination and then co-relating it radiologically and focuses on the importance of broad-spectrum antibiotics when necessary investigation (biopsy in our case) is denied.