The First Reported Case Worldwide of Chronic Gossypiboma Complicated by Secondary Tuberculous Psoas Abscess from Pott’s Disease: A Case Report Highlighting Diagnostic Anchoring

Tuberculous psoas abscess secondary to spinal tuberculosis (Pott’s disease) is a significant clinical challenge across the world. While gossypiboma (retained surgical gauze) is a known surgical complication, its coexistence with an active mycobacterial infection presents a unique presentation. Here we reported the first documented worldwide case of a secondary tuberculous psoas abscess arising from Pott’s disease coexisting with a chronic gossypiboma in a 42-year-old woman. The diagnosis was missed for three years, during which her symptoms were mistakenly treated as recurrent urinary tract infections. Radiological imaging showed a large psoas abscess alongside a pelvic mass. A laparoscopic procedure revealed a large abscess and an encapsulated retained surgical gauze with dense adhesions (pseudocyst) that was removed. Mycobacterium culture confirmed the diagnosis; anti-tuberculous therapy was promptly initiated. We hypothesized that the gossypiboma may have provided a sequestered environment, potentially “hiding” or exacerbating the tuberculous process. This case shows the significant dangers of diagnostic anchoring and the importance of reconsidering diagnoses when treatment fails in patients with non-resolving symptoms. Managing such complex presentations of surgical and infectious pathologies requires a high index of suspicion and a multidisciplinary approach.