Fatal meningitis secondary to undetected bacterial psoas abscess. Report of three cases.

Three unusual cases of fatal meningitis secondary to undetected bacterial psoas abscess occurred at this institution over an 11-year period. All three patients had suffered chronic debilitating disorders before the abscess formation. The superimposed variable clinical presentations led to the initial diagnosis of a progressing cerebrovascular accident in one case, herniated nucleus pulposus at the L3-4 level in another, and osteomyelitis of the hip joint in the third. Analysis of these cases revealed that before the meningeal dissemination, all of the patients had shown evidence of intraabdominal pathology with positive psoas signs. Diagnostic and therapeutic guidelines are discussed.