Psoas fistula and abscess in a patient with Crohns Disease presenting as claudication and hip arthritis

Crohn’s disease is characterized by chronic intestinal inflammation and not rarely by extraintestinal manifestations. Psoas abscess and fistula is a rare complication of Crohn’s disease, which is sometimes difficult to diagnose in the early stage. We describe the case of a 22-year-old male patient with Crohn’s disease who presented to us with difficulty in walking and pain in the area of the right hip. A MRI scan of the hip joints was negative for aseptic necrosis of the head of femur. An ultrasound examination of the lower abdomen was also negative, as were the X-rays of the sacral bone and sacroiliac joints. The patient was treated with non-steroidal anti-inflammatory agents but his condition worsened and he developed diarrhoea. Subsequently, he developed fever and local tenderness of soft tissues of the right hip and buttock. A C/T scan at this stage revealed a psoas abscess and a fistula in the area of psoas muscle. The patient was treated with antibiotics and octreotide and his condition improved dramatically and the symptoms resolved. The differential diagnosis of sudden onset of claudication and pain in the hip in a patient with Crohn’s disease should include the presence of a psoas abscess.