Pott's disease and tuberculous psoas abscesses in a patient with acquired immunodeficiency syndrome

. As she could notachieve relief of the back pain with analgesics, she was hospitalizedfor evaluation. At physical examination, she was thin and pale,with diffuse abdominal pain and tender enlargement of the liver. Tuberculin skin test was negative. Chest x-ray was normal,but roentgenography of the back revealed lytic lesions of the lastlumbar vertebrae, with collapse of the body of L5 (Figure A).Abdominal computed tomography (CT) showed abscesses in thepsoas major muscles bilaterally (12x15cm), extending to the rightto ileo-psoas and iliac muscles (Figure B), with paraaortic andmesenteric lymphadenopathy. The abscess on the right was drainedpercutaneously under CT guidance. A catheter was inserted afterthe drainage of 1,000ml of pus. Cultures of the left abscess drainagewere negative for pyogenic bacteria, but Ziehl-Neelsen stains werepositive on three different occasions. She was started on rifampin,isoniazid and pyrazinamide, and given tramadol for analgesia. This,with immobilization of the spine, led to clinical improvement.Abdominal CT scan performed two months after starting treatmentshowed incomplete involution of the abscesses (5x7cm). Atuberculous abscess of the psoas may develop secondary to spinaltuberculosis, but rarely presents as a primary manifestation.Paciente de 31 anos, do sexo feminino, com diagnostico deAIDS ha cerca de dois anos, tendo ja apresentado como complicacoesoportunistas coriorretinite por citomegalovirus (CMV) e candidiaseesofagica. Estava, ha um ano, em uso de estavudina, lamivudina eefavirenz, e profilaxia para CMV e