Neonatal iliopsoas abscess: A case report

Iliopsoas abscess (IPA) is a rare and potentially challenging condition in neonates, particularly in resource-limited environments. A term female neonate, born at 38 weeks gestation, presented at 28 days of age with an 18-day history of left thigh swelling, reduced limb movement, and fever. Initial treatment at an outside facility consisted of intravenous ampicillin-cloxacillin for two days, after which she was discharged without oral antibiotics. Ultrasound imaging at our facility revealed a 220 ml fluid collection in the left iliopsoas muscle and the left anteromedial compartment of the thigh. Surgical drainage was performed on day of life 30 via an incision through the lumbar triangle of Petit, with placement of a non-suction drain. Intravenous antibiotics were subsequently changed to vancomycin, metronidazole, and gentamicin. The abscess recurred on day of life 38, necessitating a second surgical drainage, which yielded 30 ml of thin pus mixed with blood. Following the second drainage, the patient improved and was discharged on oral cephalexin for 14 days. At the one-month follow-up, she exhibited satisfactory progress, with no asymmetry in movements or any tissue swelling. Neonates with swelling of the inner aspect of the thigh should undergo an ultrasound to rule out an iliopsoas abscess. Patients should be closely monitored for early recurrence after a surgical drainage, even if they are still under antibiotic treatment.