Post-Partum Ilio-Psoas Abscess. A Rare Case of Puerperal Sepsis with Streptococcus Agalactiae

Mrs. A a 41 years old gravida 6 para 5 lady delivered vaginally, with spontaneous onset of labour at 39 weeks of gestation under epidural analgesia with intact perineum. She had a regular antenatal care at a large tertiary care center. Her antenatal risk factors were a high body mass index and mild anemia with a normal Glucose tolerance test and no other medical or surgical co morbidities. Day one post vaginal delivery she started complaining of left hip and back pain restricting her mobility. Her pain was of new onset and described as spasm like and starting from left hip and radiating to the whole of her left leg. An initial management plan was conservative in form of analgesia and although she had some relief from the pain aspect, yet she started complaining of lower abdominal pain, left back pain and left hip pain with radiation till the toes with inability to walk and presence of fever with chills. Neurology consultation was done, and an urgent MRI performed which revealed edema and swelling in the left posterior Para spinous muscles at L4-S2 level. There was also edema and swelling noted in the left iliacus muscle and adjacent psoas muscle with extension to the pelvis. There were three small foci of collection noted in the inflamed left iliacus muscle; the largest one is measuring 13 mm in diameter. Minimal edema was noted in the left upper gluteus muscles. Minimal fluid collection noted in the left sacroiliac joint with marrow edema in the adjacent left iliac bone. Grade 1 anterolisthesis of L5 over S1 vertebra was noted. No significant degenerative changes in the lumbar spine was noted. No obvious epidural hematoma was noted.