Background: Psoas abscess is a rare and complex entity with poor clinical manifestation. The etiologies are usually in relation to the neighboring structures. Imaging modalities help in diagnosis and guide therapeutic decisions. Complications are rare and generally associated with a delayed diagnosis. Case Presentation: We are presenting the case of a 55-year-old male immune-compromised patient who presented with an acute generalized peritonitis and was found at laparotomy to have an intraperitoneal rupture of a psoas abscess. We performed peritoneal lavage, drainage, post-operative broad spectrum antibiotherapy and resuscitation which were unsuccessful since the patient died on the 4th day post-operative. Conclusion: Delayed diagnosis of a complicated psoas abscess in an immunocompromised patient can lead to a fatal outcome despite surgery and antibiotics.
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