This correspondence is in relation to the dilemma regarding primary and secondary psoas abscess as pointed recently [1].

There remains no doubt that primary abscesses are due to a hematogenous spread due to bacteremia and secondary abscess occurs as a result of direct spread of infection from an adjacent structure [2,3]. A case of primary psoas abscess with spondylodiscitis was published earlier by us [4]. Hernández-Ros, et al. commented that all authors must use the recent classification criteria and accordingly, that patient should have been diagnosed as secondary rather than primary psoas abscess.

We disagree because our patient, a 26 day-old-neonate, presented with clinical features of septicemia and it was clearly mentioned that the isolates of methicillin resistant staphylococcus aureus (MRSA) was detected in the blood culture. Hematogenous spread of infection following the bacteremia resulted in the psoas abscess. Discitis with vertebral body destruction following primary abscess was a unique presentation in this age group. Referring to the new classification criteria, as also pointed out by Hernández-Ros et al., the hematogenous spread of the infection in our case clearly established the diagnosis of primary psoas abscess beyond any doubt. Our diagnosis of primary was not on the basis of organism. It was not the local spread of infection from nearby structure; hence it cannot be labeled as secondary psoas abscess.

1. Hernández-Ros R, Hernández-Belmonte A. Psoas Abscess: Primary or Secondary? Indian Pediatr. 2013;50:345-6.

2. Dos Santos VM, Silva Leao CE, Borges Santos FH, Fastudo CA, Machado Lima RL. Iliopsoas abscess and spondylodiscitis by Staphylococcus aureus: successful clinical treatment. Infez Med. 2011;2:120-4.

3. Navarro López V, Ramos JM, Meseguer V, Pérez Arellano JL, Serrano R, García Ordóñez MA, et al. Microbiology and outcome of iliopsoas abscess in 124 patients. Medicine (Baltimore). 2009;88:120-30.