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Case Report A 26-year-old African American male with a history of HIV and CD4 count of 507 on HAART was sent to the Emergency Department after a biopsy of a psoas muscle collection demonstrated pustular drainage. The patient reported that approximately three weeks prior to presentation he was found to have elevated liver function tests on routine labs at his primary care office. Subsequently, the patient was sent for an abdominal ultrasound and CAT scan which showed a confluence of lymph node surrounding the porta hepatis as well as a psoas muscle collection. In review of systems, he reported chronic left-sided weakness and occasional muscle tightness in both legs. He denied weakness on the right side, as well as, fevers, chills, cough or shortness of breath. The physical exams was unremarkable except for 4/5 weakness in the left lower extremity. Radiographic imaging (Figure 1) revealed fluid collection in the psoas muscle and abscesses in the liver and spleen. The patient was admitted to the hospital and started on vancomycin. His abscess was drained but the culture did not reveal any organisms. In order to obtain a fluid sample, surgery performed an exploratory laparoscopy of the fluid collection. The direct smear showed acid fast bacilli and the PPD demonstrated induration. Based on these findings, patient was diagnosed with tuberculosis and started on appropriate therapy.

A Case Report of a Patient With Liver, Psoas Muscle and Porta Hepatis Abscesses