Acute Bacterial Sacroiliitis in an Adult: A Case Report and Review of the Literature

doi:10.1016/j.apmr.2007.07.004

Archives of Physical Medicine and Rehabilitation

Volume 88, Issue 10, October 2007, Pages 1357-1359

https://doi.org/10.1016/j.apmr.2007.07.004 Get rights and content

Abstract

Bindal M, Krabak B. Acute bacterial sacroiliitis in an adult: a case report and review of the literature.

Bacterial septic sacroiliitis is an uncommon diagnosis that occurs most frequently in children and young adults. Nonspecific physical examination findings often make it difficult to diagnose the condition, thus delaying appropriate treatment. We review the case of middle-aged woman with sacroiliac joint (SIJ) pain after a torsional injury. Radiographic films showed the pelvis and left lower extremity to be normal. Despite anti-inflammatory medications, analgesics, a corticosteroid injection, and physical therapy, her pain persisted. Laboratory data showed an elevated erythrocyte sedimentation rate and C-reactive protein; otherwise, tests were normal, including negative blood cultures. Magnetic resonance imaging (MRI) revealed a left posteroinferior SIJ effusion and computed tomography (CT) showed an effusion and irregularity in the left SIJ. An SIJ biopsy revealed inflammation suggestive of osteomyelitis. After a course of intravenous antibiotics, the symptoms completely resolved, thus supporting our diagnosis of bacterial sacroiliitis. Repeat MRI and CT confirmed the complete resolution of the sacroiliitis.

Section snippets

Case Description

A 40-year-old woman without significant medical history presented to our clinic with a 2-week history of pain in the left gluteal region. She said her pain began after she lurched forward while carrying her luggage at the airport. The pain was sharp and progressed over the next several hours while she was on the aircraft, prompting her to seek an evaluation in the emergency department. Radiographs showed no abnormalities in the pelvis and hip. The patient was treated for a muscle strain and was

Discussion

Bacterial septic sacroiliitis is more typically seen in children and young adults than in middle-aged or elderly persons.⁵ In adults, there is often a history of intravenous drug use, skin and respiratory infections, or genitourinary tract infections. It is thought that the majority of septic sacroiliitis cases occur through hematogenous seeding from a preexisting infection from a distant site.2, 5 Others have suggested it is the result of local spreading of infection from a spinal or pelvic

Conclusions

Infectious SIJ disease can be difficult to diagnose, given the nonspecific symptoms and physical examination findings. Clinicians should be aware of the diagnosis, however, even in the acute setting or in unilateral cases. With appropriate laboratory and imaging workup, the appropriate treatment can be initiated without delay and without any long-term complications. As was true for our patient, the proper identification of bacterial septic sacroiliitis frequently leads to a positive outcome.

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Cited by (21)

Septic sacroiliitis in the post-partum period with haematogenous spread
2021, IDCases
Citation Excerpt :
In a review of 15 patients in the pregnant/postpartum period by Imagama et al. only 3 cases were managed with open drainage with a further single patient requiring a hysterectomy and oophorectomy [8]. Septic sacroiliitis remains an important differential given immunosuppression of pregnancy and hypothesised hormonal effects on joint laxity; albeit limited, literature certainly suggests pregnancy may be an independent risk factor for its development [6–8,12]. The case presented here represents another rare presentation of septic sacroiliitis with disseminated infection and haematogenous spread adding to a small but significant number of patients making septic sacroiliitis a differential to always consider in the post-partum patient presenting with non-resolving, severe pelvic pain.
Pelvic pain is a very common gynaecological complaint especially during the puerperium. It is rarely associated with development of septic sacroiliitis or haematogenous spread to other sites within the body. The case below demonstrates a 30 year old female 10 days post-partum presenting with left hand cellulitis secondary to development of septic sacroiliitis. Her case supplements a small cohort of reports among literature identifying septic arthritis in the postpartum period, recognises the delay to diagnosis and increased morbidity of this condition.
Septic sacroiliitis in the late postpartum due to Escherichia coli
2016, Revista Colombiana de Reumatologia
La sacroiliitis séptica es una condición inusual, a menudo el diagnóstico se hace de forma tardía debido a la poca especificidad de los síntomas. Debe ser sospechada en casos donde coexista dolor lumbar inflamatorio y signos de respuesta inflamatoria sistémica, especialmente en personas con factores de riesgo tales como el puerperio. En este artículo reportamos el caso de una mujer quien durante el puerperio tardío presentó sacroiliitis por Escherichia coli y sepsis grave secundaria, siendo este el segundo caso reportado de sacroiliitis séptica por Escherichia coli asociada al embarazo.
Septic sacroiliitis is an unusual condition, and due to its non-specific symptoms, the diagnosis is often delayed. It should be suspected in cases in which inflammatory back pain and systemic inflammatory signs co-exist, especially in people with risk factors, such as postpartum. The case is presented of a woman, who in the late postpartum, presented with sacroiliitis and severe sepsis due to Escherichia coli. This is the second report of a case of septic sacroiliitis due to Escherichia coli associated with pregnancy.
Sacroiliitis and gluteal abscess secondary to Staphylococcus aureus infection
2015, Reumatologia Clinica
Benign osseous and articular abnormalities of the pelvis: A review of CT imaging findings
2015, Clinical Imaging
Citation Excerpt :
It is more typically seen in children and young adults than in the middle-aged or older adults. Diagnosis is often difficult due to the nonspecific clinical presentation [8]. Infection of the SI joint may occur via hematogenous seeding or from local extension of an infectious process.
Computed tomography (CT) has become the standard of care for evaluation and follow-up for a wide range of abdominal and pelvic pathology. Many incidental osseous and articular abnormalities of the pelvis are detected on these studies, most of which have a benign etiology. However, most of these studies are interpreted by nonmusculoskeletal radiologists, who may not be familiar with the CT appearances of these benign musculoskeletal abnormalities. Uncertainty often leads to mischaracterization or unnecessary follow-up, resulting in increased health care costs and patient anxiety. This article reviews the CT appearance of the benign musculoskeletal entities that occur in pelvis.
Profile of infectious sacroiliitis among rheumatology inpatients in Lomé (Togo): A single center experience
2014, Egyptian Rheumatologist
Citation Excerpt :
Infectious sacroiliitis is rare, involving between 1% and 2% of septic arthritis cases, which is probably due to the poor vascularization of this joint resulting in a low risk of infection via the haematogenous route [1,2]. Most observations are based on single case reports and review of the literature [3–8], small case series [9,10] or multicentre studies [11]. The diagnosis of osteoarticular infection is difficult in these anatomical sites and may be delayed due to the poor specificity of clinical signs and symptoms [1,12–14].
To determine the epidemiological, clinical, bacteriological, and radiological characteristics of infectious sacroiliitis in patients admitted to the Rheumatology Department in Lomé (Togo).
A retrospective study was conducted over 21 years on files of hospital patients admitted for infectious sacroiliitis.
Of the 2995 patients admitted, 359 suffered from infectious arthritis, and 18 cases suffered from infectious sacroiliitis (5%). The mean age at admission of those 18 patients (seven men, eleven women) was 34.22 ± 13.5 years while the mean disease duration was 22.05 ± 41.9 days. The onset was sudden in 14 patients. The sacroiliitis was essentially unilateral (17 patients). The pain which was essentially inflammatory (16 patients), had irradiated in 14 patients. Fever was observed in 16 patients while weight loss was seen in 11. The infectious gate has been found in 15 patients (88.3%) with a post-partum period in five patients (27.8%). Limpness has occurred in 12 patients. Erythrocyte sedimentation rate was high in 13 patients with a mean of 78.83 ± 15.21 mm/1st hour. Of the 18 patients, pathogenic agents were isolated in 8 (Staphylococcus aureus: 7 cases, Mycobacterium tuberculosis: 1) and probable infection by Mycobacterium tuberculosis in another. Pathogenic agents were detected by cytobacteriological examination of vaginal sample in 5, urine in 2, sputum in 1 and psoas puncture in another. The mean antibiotic therapy duration was 3.25 ± 3.1 months. Followed up 6-months later the patients improved well.
Our series confirmed that infectious sacroiliitis is rare and there is no clinical, bacteriological, and radiological particularity.
What is Your Radiologic Diagnosis?
2022, Cocuk Enfeksiyon Dergisi

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Clinical noteAcute Bacterial Sacroiliitis in an Adult: A Case Report and Review of the Literature

Abstract

Section snippets

Case Description

Discussion

Conclusions

J Arthroplasty

Arch Phys Med Rehabil

J Pediatr

Inciting events initiating injection-proven sacroiliac joint syndrome

Pain Med

Acute pyogenic sacroiliitis without predisposing conditions

Spine

Pyogenic infection of the sacroiliac joint: case reports and review of the literature

Medicine

Septic sacroiliitis

Semin Arthritis Rheum

The sacroiliac joint: a review

Int Spinal Injection Soc

Intertester reliability for selected clinical tests of the sacroiliac joint

Phys Ther

Clinical examination of the sacroiliac joint: a prospective study

Arthritis Rheum

Clinical note
Acute Bacterial Sacroiliitis in an Adult: A Case Report and Review of the Literature