Abstract / Summary
Pressure injuries are common in immobilized patients, but extension into deep pelvic compartments with formation of an iliopsoas abscess is exceedingly rare and potentially life-threatening. Because symptoms are insidious and the clinical presentation is atypical, early diagnosis is frequently delayed, particularly in patients with sensory impairment. This case report highlights a rare and severe complication of a sacrococcygeal pressure injury and underscores the importance of precise imaging and multidisciplinary management. A 48-year-old East Asian man with a history of spinal cord injury and long-term immobility presented with extensive sacrococcygeal and bilateral ischial pressure injuries accompanied by purulent discharge and systemic infection. On admission he was in sepsis with markedly elevated inflammatory markers. Computed tomography revealed a deep soft tissue infection extending into the right iliopsoas muscle with abscess formation, together with involvement of adjacent pelvic structures. He underwent staged, multidisciplinary management comprising diverting colostomy, extensive surgical debridement, computed tomography-guided abscess drainage, negative-pressure wound therapy, and subsequent pedicled flap reconstruction. With appropriate source control, targeted antimicrobial therapy, and nutritional support, the iliopsoas abscess resolved completely and the wound healed satisfactorily. No recurrence was observed during follow-up. This case demonstrates that an iliopsoas abscess secondary to a sacrococcygeal pressure injury, although rare, should be considered in critically ill or neurologically impaired patients who develop deep or atypical infections. Early targeted computed tomography imaging is essential for accurate diagnosis and treatment planning. A staged, multidisciplinary approach that prioritizes prompt drainage, infection control, and definitive reconstruction can yield favorable outcomes even in severe cases.