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Clinical Images: Iliopsoas bursa rupture mimicking psoas muscle abscess
The patient, a 49-year-old woman with psoriatic arthritis treated with infliximab and methotrexate, was admitted to the hospital with
a 3-day history of sudden-onset right hip pain and fever up to 39°C with rigors. Magnetic resonance imaging (MRI) (left) and
computed tomography (CT) (right) revealed swelling in the right iliac, pectineal, and obturator muscles and probable fluid
collection in the right iliac muscle, consistent with intramuscular abscess. CT-guided percutaneous drainage yielded only 1 ml of
serous fluid; bacterial cultures, including studies for Mycobacterium, were negative. Further inquiry into the patient’s history
revealed that she often squatted while playing with children as a kindergarten teacher. Her symptoms improved upon treatment with
nonsteroidal antiinflammatory drugs (NSAIDs) alone, and she was discharged on the sixth hospital day with a diagnosis of iliopsoas
bursa rupture. She continued to receive infliximab and methotrexate along with NSAIDs. Followup MRI 2 months later showed
almost complete resolution.
Hiromichi Tamaki, MD
Mitsumasa Kishimoto, MD, PhD
Masato Okada, MD
St. Luke’s International Hospital
DECREASED RISK OF CANCER IN PATIENTS WITH GCA1769