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I devop this pustule along with back pain and tenderness on opposite outer aspect of gluteal region. As I had a history of absecess in perianal region which drained around 2 years ago. Is there any connection like psoas abscess or any other internal abscess or is it musculoskeletal cause

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cd /tmp/workspace && mkdir -p img && python3 -c " from PIL import Image im=Image.open('attachments/25d600ea-f7ce-4f45-9cb9-443becc30094/IMG20261111210957.jpg'); print(im.size) im.thumbnail((1400,1400)); im.save('img/small.jpg',quality=80) "; ls -la img

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"psoas abscess"[MeSH Terms]

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From the photo and your history, a psoas or other internal abscess is possible but not the most likely explanation. I can't rule it out without an exam and some tests, so I'd have it checked soon. The photo is blurry and dark. It shows a tiny raised spot with a whitish tip at the upper left and fine sweat-like beads on the skin. I can't tell whether it is a folliculitis pustule, a boil or something else.
Why a deep abscess is less likely
  • A perianal abscess that drained 2 years ago rarely causes a psoas abscess. Psoas abscesses usually come from bowel disease or from infection in the spine.
  • Textbooks list advanced Crohn's disease, diverticulitis or perforation, and spinal osteomyelitis or TB as the usual sources. They commonly present with fever, back or lower abdominal pain, and pain referred to the hip or knee (Bailey and Love's Short Practice of Surgery 28th Ed, Retroperitoneal (psoas) abscess; Harrison's 22E, Perinephric and Renal Abscesses).
  • The classic psoas signs are a limp, the hip held flexed and externally rotated, and pain when you extend the hip (Campbell Walsh Wein Urology, Perinephric Abscess).
  • A pustule on one buttock with tenderness on the other side doesn't fit a single connected track, so two separate problems are likely. A contralateral spread from a perianal abscess would be unusual.
What the perianal history does matter for
  • A drained perianal abscess can leave a fistula-in-ano, or the abscess can recur. Deep ischiorectal or supralevator extensions can cause buttock pain, but they usually come with local swelling, a painful sitting posture, and sometimes fever.
  • Recurrent perianal or buttock abscesses should also prompt consideration of Crohn's disease or hidradenitis suppurativa, because both can cause new pustules on the buttocks. Have you had diarrhea, blood or mucus in the stool, weight loss, or other recurrent boils (armpits, groin)?
Other likely causes
  • Skin: simple folliculitis or a small boil, which is common and often unrelated to the back pain.
  • Early shingles: this is possible if the pustule or vesicle sits in a band on one side and the pain is burning or sharp in the same area.
  • Musculoskeletal: piriformis or gluteal myofascial pain, sacroiliac joint dysfunction, lumbar disc or facet pain referred to the buttock, or trochanteric bursitis. These fit best if the pain changes with posture, sitting, bending, or pressing on a spot, and you have no fever.
Signs that point toward an internal abscess
  • Fever, chills or night sweats.
  • Pain that is steady and worsening, or present at rest and at night.
  • A limp, or pain when you straighten the hip, or you prefer to keep the hip bent.
  • A swelling or hard area in the buttock, groin or flank.
  • Diarrhea, blood in the stool, or weight loss.
  • Diabetes or low immunity.
  • Leg weakness, numbness, or trouble passing urine or stool. This needs urgent care.
What I'd suggest
  1. Don't squeeze the pustule. Keep it clean and dry, and use warm compresses.
  2. See a doctor within a day or two. Go the same day if you have fever, worsening pain, spreading redness, or any of the signs above.
  3. Reasonable tests if the exam raises concern are a CBC, CRP/ESR and blood sugar. An MRI of the pelvis can look for a perianal fistula or a deep collection, and a CT or MRI of the abdomen and spine can look for a psoas collection or spinal infection.
  4. A surgeon or proctologist exam of the perianal area is worth doing, given the earlier abscess.
To narrow this down, tell me which side the pustule and the pain are on, whether you have fever or a limp, and whether the pain changes with movement or sitting. A sharper, closer photo of the spot would help too.
A quick PubMed check for recent meta-analyses on psoas abscess found nothing that changes this textbook picture. I can't diagnose you from this information, so please get examined.
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