Massive Tuberculous Psoas Abscess Secondary to Spinal Tuberculosis: A Rare Clinical Presentation

Psoas abscess is a rare and often overlooked manifestation of extrapulmonary tuberculosis. Because of its non-specific clinical presentation, diagnosis is frequently delayed, which may lead to significant morbidity. We report the case of a 41-year-old man who presented with progressively worsening low back and right hip pain, gait disturbance, and unintentional weight loss. His medical history was remarkable for blunt trauma to the right pelvic region one year earlier. On admission, inflammatory markers were markedly elevated, while physical examination revealed tenderness over the right hip and inguinal region. Abdominal ultrasonography suggested an abscess formation, which was further characterized by magnetic resonance imaging. Ultrasound-guided percutaneous drainage was performed, yielding a total of 1,850 mL of purulent material. Mycobacterium tuberculosis complex was isolated from the abscess culture on day 28, and standard anti-tuberculosis therapy was subsequently initiated. Following treatment, the patient’s gait disturbance and pain improved significantly. This case emphasizes that tuberculous psoas abscess should be considered in the differential diagnosis of persistent musculoskeletal pain, even in the absence of active pulmonary tuberculosis. A combination of image-guided percutaneous drainage and anti-tuberculosis therapy remains an effective and less invasive treatment strategy.