Spontaneous Renocutaneous Fistula: Case Report

Psoas muscle abscess is a rare condition in clinical practice. It occurs with diabetes, urogenital tract neoplasia or with severe immunodeficiency. Sometimes opening skin fistula is developing in the area of tissue infiltration. Computerized tomography with intravenous contrast material is a perfect initial examination to prove a soft tissue tract along the fistula and extent of inflammation. In reviewing several studies dealing with perirenal abscesses, which complicated skin opening fistula, literature recommends conservative treatment with antibiotics to the disease agent and suitable fistula drainage of pus escape. Sometimes opening skin fistula is developing in the area of tissue infiltration. This article describes the case of a 69-year old patient with a constantly appreciating fistula in the skin. The woman arrived at the hospital complaining of low-grade fever, pain in the left side, suppuration of the left side of the fistula. The patient had urogenital system tuberculosis in her youth, even this diagnosis was successfully healed. Fistula repeatably opens 1-2 times per year. Laboratory tests showed leukocytosis, elevated serum creatinine. From fistula pus grew Achromobacter xylosoxidans and Streptococcus anginosus. The pelvic computerized tomography detected abscess covering the big lumbar muscle, kidney infiltration and opens to the lateral abdominal wall. Treatment started by crystalloid infusion and antibiotics. After antibacterial treatment for decreased inflammatory indicators, fistula was almost closed, it was no longer purulent secretions.