BMJ Case Reports 2009; doi:10.1136/bcr.01.2009.1499
  • Unusual association of diseases/symptoms

Images in a patient on chronic haemodialysis with low back pain and Staphylococcus septicaemia

  1. Lin-Nei Hsu1,
  2. Huey-Liang Kuo2,
  3. Shu-Ming Wang1,
  4. Jiung-Hsiun Liu2,
  5. Yao-Lung Liu2,
  6. Che-Yi Chou1,
  7. Chiu-Ching Huang2
  1. 1
    China Medical University Hospital, Internal Medicine, No. 2 Yude Road, North District, Taichung, 40461, Taiwan
  2. 2
    China Medical University Hospital, No. 2 Yude Road, Taichung, 40461, Taiwan
  1. Che-Yi Chou, cychou.chou{at}
  • Published 10 August 2009


A 47-year-old man with history of alcoholic liver cirrhosis (Child–Pugh class C) and end stage renal disease was admitted because of bilateral flank pain for 2 weeks. He started haemodialysis (HD) via left femoral double lumen because of hyperkalaemia 1 month before admission. He denied a history of muscle strain or trauma and his low back pain got worse while bending forward. He also had intermittent low-grade fever. Physical examination revealed left flank knocking tenderness. His white blood cell count was 10.43×103 cells/μl and C-reactive protein was 18.92 mg/dl. An abdominal CT scan showed focal abscesses from the left diaphragm to the left psoas muscle (fig 1). The blood culture revealed methicillin-resistant Staphylococcus aureus septicaemia. Study of a transoesophageal echocardiogram showed no vegetation and the findings of an osteomyelitis scan were unremarkable. His low back pain resolved 2 weeks later after treatment with vancomycin and rifampicin. The follow-up abdominal CT scan showed a resolution of the psoas muscle abscess (fig 2).

Figure 1

Left psoas muscle abscess: a hypodensity area in the left psoas muscle can be seen.

Figure 2

There is no hypodensity area found in left psoas muscle after vancomycin and rifampicin treatment, suggesting a resolution of left psoas muscle abscess.

S aureus is one of the most common causes of infection1 and low back pain is a common symptom in patients on chronic HD.2 The causes of low back pain in patients on chronic HD include nerve root compression, injury muscles, ligaments and joints; cauda equina syndrome, infection and tumours. Psoas abscess in patients on HD could be caused the contiguous vascular access device such as a femoral double lumen.3 Clinical history and physical examination are the key factors for diagnosis.


  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.


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