Psoas Abscess in a Post-Nephrectomy Patient with Decompensated Liver Cirrhosis: A Case Report Illustrating the Intersection of Surgical Alteration and Immune Dysfunction

Abstract

Introduction

Psoas abscess (PA) is an uncommon condition, particularly in patients with altered retroperitoneal anatomy or compromised immunity. We report a case of a delayed psoas abscess in a patient with a prior right nephrectomy and decompensated liver cirrhosis (DCLD). While psoas abscesses following nephrectomy or in the setting of cirrhosis are documented separately, this case illustrates a unique intersection of these factors. We propose the concept of “Chronic Latent Deep Nidus Formation” (CLDNF) as a descriptive framework for discussing how dormant surgical site infections might reactivate in the context of systemic immune dysfunction.

Case Presentation

A 60-year-old male presented with abdominal distension and low-grade fever. Initially managed for spontaneous bacterial peritonitis (SBP), the ascitic fluid analysis was non-revealing. Cross-sectional imaging revealed a large right psoas abscess extending into the ipsilateral nephrectomy bed, and microbiological culture identified Klebsiella pneumoniae. The patient improved following percutaneous drainage and targeted antibiotic therapy.

Discussion

This case describes a rare and diagnostically challenging condition, Psoas abscesses that developed years after nephrectomy in a patient with decompensated chronic liver disease (DCLD). The case provides additional clinical insight into the diagnostic complexity and management of atypical infections in cirrhotic patients. The microbiological etiology of psoas abscesses varies according to geographic region and host-related factors. In our patient, Klebsiella pneumoniae, exclusively isolated from the abscess fluid, supports the possibility of a localized infectious process rather than hematogenous dissemination. It’s plausible that delayed post-nephrectomy psoas abscesses could be related to residual infective foci, altered retroperitoneal anatomy, or delayed bacterial colonization.

Conclusion

This case provides clinical insight into how altered anatomical spaces may harbor subclinical infection that reactivates within the permissive environment of cirrhosis-associated immune dysfunction (CAID).