A 69-year-old Chinese farmer suddenly developed severe lower back pain accompanied by persistent high fever while recovering from carbon monoxide (CO) poisoning. Clinical examination showed limited mobility of the spine and significant tenderness in the L2–L4 vertebrae and bilateral paravertebral regions, without palpable masses. Magnetic resonance imaging (MRI) revealed fluid accumulation around the bilateral psoas muscles, confirming bilateral abscesses. Ultrasound-guided puncture and drainage of the affected area were performed. Culture of the drainage fluid identified Carbapenem-Resistant Enterobacteriaceae (CRE). The final diagnosis was bilateral primary psoas abscess (PPA). Targeted antimicrobial therapy for CRE infection was initiated.