The University of Toledo Translation Journal of Medical Sciences 
Infectious Diseases Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

An Alprostadil Intracavernosal Injection 
Leading to a Psoas Muscle Abscess 
K.K. Girdhar, MPH1*, M. Deutsch, J.A. Kammeyer, MD, MPH 

1Division of , Department of Medicine, The University of Toledo, Toledo, OH 43614 
2Division of, Department of Medicine, The University of Toledo, Toledo, OH 43614 
3Division of, Department of Medicine, The University of Toledo, Toledo, OH 43614 

*Corresponding author: joel.kammeyer@utoledo.edu

Published: 05 May 2023 

Introduction: Alprostadil is a synthetic prostaglandin E1 that can be self-administered via 
intracavernosal injection as a vasodilatory treatment for erectile dysfunction. The psoas muscle has close 
anatomical relationships such as to the ureters and renal pelvises, and is vulnerable to infection from 
regional structures. Lumbar artery derivatives supply the muscle. Primary psoas abscess is often 
associated with trauma, while Crohn’s disease is linked to secondary abscess.  

Case Presentation: A 59-year-old male presented with a three-week history of fevers, chills, and body 
aches. Eight months prior, the patient had undergone laparoscopic prostatectomy with bilateral pelvic 
lymph node dissection and nerve sparing as prostate cancer therapy.  Since, the patient had reported 
stress incontinence with heavy lifting but denied hematuria, dysuria, flank pain, or testicular pain. The 
patient was diagnosed with erectile dysfunction related to prostatectomy and received intracavernosal 
alprostadil and combination treatment with sildenafil six months.  Imaging revealed a loculated, 
peripherally-enhancing fluid collection in the hemipelvis along the inferior margin of the right psoas 
muscle.  Blood and urine cultures were negative.  An abscess aspirate sample revealed methicillin-
sensitive Staphylococcus aureus. The patient was treated with cefazolin 2g IV every eight hours for six 
weeks.   

Discussion: The case offers an example of intracavernosal injection of alprostadil precipitating psoas 
muscle abscess, as opposed to more common cavernous or penile abscesses. Psoas abscess can arise 
from contiguous spread from adjacent structures or by the hematogenous route from a distant site. This 
case highlights the importance of considering intracavernosal injections as potential local introduction 
mechanisms for psoas infection. 

https://dx.doi.org/10.46570/utjms.vol11-2023-752 

https://dx.doi.org/10.46570/utjms.vol11-2023-752
mailto:joel.kammeyer@utoledo.edu