Psoas fistula and abscess in a patient with Crohn’s Disease presenting as claudication and hip arthritis

Abstract

SUMMARY
Crohns disease is characterized by chronic intestinal inflammation
and not rarely by extraintestinal manifestations.
Psoas abscess and fistula is a rare complication of
Crohns disease, which is sometimes difficult to diagnose
in the early stage. We describe the case of a 22-year-old
male patient with Crohns disease who presented to us with
difficulty in walking and pain in the area of the right hip. A
MRI scan of the hip joints was negative for aseptic necrosis
of the head of femur. An ultrasound examination of the
lower abdomen was also negative, as were the X-rays of the
sacral bone and sacroiliac joints. The patient was treated
with non-steroidal anti-inflammatory agents but his condition
worsened and he developed diarrhoea. Subsequently,
he developed fever and local tenderness of soft tissues
of the right hip and buttock. A C/T scan at this stage revealed
a psoas abscess and a fistula in the area of psoas
muscle. The patient was treated with antibiotics and octreotide
and his condition improved dramatically and the
symptoms resolved. The differential diagnosis of sudden
onset of claudication and pain in the hip in a patient with
Crohns disease should include the presence of a psoas abscess.
Key words: Crohns disease, claudication, psoas abscess,
psoas fistula, hip pain.