Iliopsoas abscess (IPA) has been deemed a rare clinical entity. Traditionally, IPA has been classified as primary if no adjacent anatomic structure could be identified as the source of infection. Primary abscesses were thought to arise from hematogenous seeding of a bruised muscle and were more frequent in younger, active, male patients. Abscesses classified as secondary occur by direct spread from adjacent structures. The most frequent cause of secondary IPA listed in medical literature continues to be intra-abdominal disease, while new cases series implicating that most cases are related to skeletal infections. We report a case of a 40-year-old man complaining of recurrent fever and lumbar dermal sinuses. He was diagnosed as primary iliopaoas abscess and received surgical debridement. However, the symptom was not improved. He kept on received several debridements in the next 4 years with no recovery. Gradually, server dynamic pain and local lumbar kyphosis were developed by abscess induced spine spondylodiscitis. He received no more surgical intervention except conservative antibiotic treatment of meropenem for 6 weeks. Then, the symptoms were significantly improved. He had no more sinuses or fever recurrence. 2 years later, the patient complains nothing except some numbness at lower limbs numbness. Orthosis is suggested while walking or sitting.