Septic Spontaneous Abortion Associated With Intrauterine Fetal Death at 8 Weeks of Gestation Complicated by Myometritis and Bilateral Psoas Muscle Abscess: A Case Report.

BACKGROUND Septic abortion is a serious, life-threatening uterine infection that can occur before, during, or after a miscarriage or termination, and when it is associated with an intrauterine fetal death (IUFD), the retained fetal tissue can be a focus for bacterial infection. This report describes the case of a 34-year-old woman with septic abortion associated with IUFD at 8 weeks of gestation, complicated by myometritis and bilateral psoas muscle abscess. CASE REPORT A 34-year-old female patient presented with severe lower back pain radiating to the right lower extremity. Diagnostic workup initially ruled out neurological lesions but identified an impending septic spontaneous abortion due to IUFD at 8.7 weeks. Following cervical ripening with misoprostol and subsequent uterine curettage, she developed persistent fever and methicillin-resistant Staphylococcus aureus bacteremia. Abdominal and pelvic computed tomography (CT) documented fluid collections involving both iliopsoas muscles bilaterally at their distal insertion, alongside smaller collections in the right external obturator and thigh musculature. No surgical drainage was required due to the limited size of the abscesses. Targeted treatment consisting of a 28-day course of intravenous vancomycin resulted in full clinical and radiographic resolution. CONCLUSIONS Iliopsoas abscess is a complex clinical entity whose diagnosis can be challenging, even more in a pregnancy context. Very few cases of psoas abscess during pregnancy have been reported in the literature, and even fewer have been bilateral. Timely diagnosis and broad-spectrum antibiotic coverage are the cornerstones of treatment.