An unusual cause of cruralgia

A 66-year-old patient was referred to the pain management center for worsening cruralgia associated with vomiting, evolving for several weeks. Medical history consisted of endovascular aneurysm repair of a juxtarenal aortic aneurysm 3 years before, with uneventful follow-up. He recently received a spinal infiltration of corticosteroids to treat his pelvic pain. Five days later, he presented to our emergency department with pain exacerbation, fever, and hypotension associated with vomiting. The patient provided written consent for this report. Abdominal pelvic computed tomography revealed a periprosthetic abscess and abscesses of both psoas muscles with many gas bubbles (A and B). The patient underwent urgent open abdominal surgery, which confirmed that aortic endograft infection extended to both psoas muscles. The infected endograft was replaced by cryopreserved allograft. Streptococcus anginosus was identified on surgical bacteriologic samples and blood cultures. The patient was discharged from the intensive care unit 2 weeks later. Although endograft infection is a rare complication (0.2%-5%), morbidity and mortality remain high (13%-58%). In addition, because of both the low incidence and a majority of indolent clinical presentations, diagnosis may be delayed, resulting in torpid septic syndromes associated with systemic complications. Early computed tomography scanning should be undertaken in the case of atypical abdominal pelvic symptoms in a patient treated by endovascular aneurysm repair.