A
REFUGEE ADOLESCENT WITH DISSEMINATED TUBERCULOSIS AND BILATERAL PSOAS
ABSCES
Sukhai R.N.,von
Lindern J.S.,Mèrelle M.E
University Children Hospital Leiden, The
Netherlands
A 15 years
old Somalian female refugee was presented at the Emergency Department
with moderate abdominal pain and a history of weight loss and
constipation since a few months. Physical examination revealed
diminished air entry in the upper part of the left lung and a tender left
abdominal area but not an acute abdomen. Further laboratory investigation:
CRP 126 mg/l, ESR 122 mm, normal liver- and renal function, haemoglobin 5,7
mmol/l without haemoglobinopathies, leucocytes 6,9 x 109 /l and
normal urine sediment and culture.HIV was negative. Radiology, CT scan, MRI
and ultrasound studies showed a large cavity in the upper part of the left
lung and large fluid collections prevertebral at the level of L4-L5 in the
retroperitoneal area with abscesses in both psoas muscles. L5 showed osteolytic
lesions and spondylodiscitis. The diagnosis of disseminated tuberculosis
was confirmed by a positive Mantoux reaction of 30x21 mm,positive
Ziehl-Nielssen,PCR and auramine staining of the early morning stomach fluid collection and finally
positive culture of the
mycobacterium tuberculosis from the sputum and the material
collected from drainage of the retroperitoneal cheese-like substance. She was treated with 4 tuberculostatic drugs: ethambutol,
isoniazide, rifampicine and pyrazinamide from the beginning because of the
great possi-bility of resistance of the mycobacterium strain in Somalia for
isoniazide. The abscesses were drained during three weeks with good result.
Conclusions: We describe a Somalian patient with disseminated tuberculosis with
a rare complication of a psoas abscess and a good recovery after treatment.
We should be aware of these complications in patients
coming from countries with endemic tuberculosis and complaining of
abdominal pain.