CASE REPORT article
Front. Med.
Sec. Infectious Diseases: Pathogenesis and Therapy
This article is part of the Research TopicDiagnosis and Treatment Strategies of Tick-borne DiseasesView all 13 articles
Gout of the iliopsoas muscle combined with tuberculosis infection leading to persistent fever:a case report and review of the literature
Provisionally accepted
- 1Guangzhou University of Chinese Medicine, Guangzhou, China
- 2Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
- 3Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
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Background: Gout involves the deposition of monosodium urate crystals in the body, which can have varied presentation but commonly presents in the peripheral joints. However, gout of the iliopsoas muscle is extremely rare. Moreover, literature regarding gout of the iliopsoas muscle combined with tuberculosis infection—which can mimic common pelvic abscesses—is even scarcer. Case presentation: A case of a psoas muscle abscess with persistently high fever following gout of the iliopsoas muscle, combined with tuberculosis infection, is reported herein. The patient was a 71-year-old woman who presented with deep, diffuse pain in the lower back and left hip, and persistently high fever for one week. She showed no response to systemic anti-infective treatment. A dual-energy CT scan showed multiple bilateral gout nodules around the iliac bone, sacrum, and proximal femur. A contrast-enhanced MRI scan revealed a large hyperdense cystic lesion extending along the iliopsoas muscle, and erosion and widening of the left sacroiliac joint. The patient received open surgical intervention for effective drainage via a para-rectus approach. Some milky tophi were scraped from the cystic lesion in the iliopsoas muscle. Intraoperative pathology of these tissues indicated the formation of gout. High-throughput gene sequencing of these tissues for various pathogens indicated divergent bacillus tuberculosis, without other bacteria, fungi, or anaerobic bacteria. A diagnosis of a pyogenic psoas abscess due to gout of the iliopsoas muscle, combined with tuberculosis infection, was made. The patient responded well to thetherapy, and had an uncomplicated recovery after anti-gout and anti-tuberculosis treatment. Conclusions: Thedevelopmentof an iliopsoasabscessas a consequence of gout in the iliopsoasmuscle combined with tuberculosisinfection, is a rareoccurrence. It could be challenging to clarify a diagnosis in this unusual case. For patients with unexplained high fever asthe main clinical symptom, systemic anti-infectivetreatment is notsolely effective. High-throughput genesequencing for various pathogens isvery helpful to diagnose and find the cause of thepathogen. Open surgical intervention using a para-rectusapproach for effective drainageis highly effective and a routine procedure.
Keywords: Gout, Iliopsoas muscle, Tuberculosis, persistentfever, diagnosis
Received: 27 Mar 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Zhang, Hu, Guan, Zeng and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mei-Ren Zhang
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