2019 Volume 62 Issue 10 Pages 680-685
The patient was a 67-year-old woman who had started treatment when diagnosed with type 2 diabetes at 39 years of age but had poor glycemic control due to poor insight into her illness. During the disease course, the left toe and right lower extremity were amputated for the treatment of diabetic gangrene. The patient was referred and admitted to our hospital due to a fever, nausea, abdominal pain, and low-back pain suggesting infectious gastroenteritis. She responded poorly to antimicrobial therapy. She was old and thus had no pathognomonic physical findings. Blood cultures and a second computed tomography scan led to a diagnosis of bilateral iliopsoas muscle abscesses caused by the low-virulent indigenous bacterium, Streptococcus agalactiae (GBS). GBS is a rare pathogenic agent of bilateral iliopsoas muscle abscesses. However, diabetic patients with poor glycemic control who have undergone a lower extremity amputation carry a risk of developing GBS infection, which may lead to bilateral iliopsoas muscle abscesses. In old diabetic patients, pathognomonic physical findings are lacking. Thus, when they present with a fever and low-back pain, bilateral iliopsoas muscle abscesses should be considered in the differential diagnosis, for which repeated careful examinations and an early diagnosis are important.
