253. Clinical and Therapeutic Particularities of Brucellar Sacroiliitis

Abstract

Abstract Background The misleading clinical presentation of brucellar sacroiliitis, which is usually confused with involvement of the lumbosacral hinge or the hip, is responsible for diagnostic and therapeutic delay. We aimed to study the epidemiological, clinical and therapeutic features of brucellar sacroiliitis. Methods We conducted a retrospective study including all patients hospitalized in the infectious disease department for brucellar sacroiliitis between 1992 and 2020. The diagnosis of brucellosis was based on positive wright agglutination test and/or positive blood cultures. Results We included 12 patients, among whom 8 were males. The mean age was 35±13 years. Ten patients consumed unpasteurized milk and 9 had a close contact with animals. Three patients were previously treated for brucellosis and 4 patients had a family history of brucellosis. The revealing symptoms were sacroiliac joint pain (7 cases) and low back pain (5 cases), associated with fever and night sweats (9 cases). There were 8 cases localized on the left side of the joint. Spondylodiscitis was associated with sacroiliitis in 3 cases and genitourinary brucellosis in one case. An accelerated erythrocyte sedimentation rate and elevated C-reactive protein levels were noted in 7 cases, anemia in 7 cases and leukopenia in 4 cases. X-ray examination of sacroiliac joints revealed thickening of the sacroiliac joint (3 cases). Bone scintigraphy, which was performed in 8 cases, showed hyperfixation of the sacroiliac joint. Sacroiliac computed tomography and magnetic resonance imaging, performed in 6 cases and 4 cases, respectively, showed signs of sacroiliitis in all cases and soft tissue abscess in 2 cases. Blood cultures were positive to Brucella in 2 cases. All patients received doxycycline and rifampicin, associated with trimethoprim/sulfamethoxazole in 2 cases. The median duration of treatment was 4.5 months [3-9 months]. The disease evolution was favorable in 10 cases. Sequelae represented by sacroiliac joint pain was noted in 4 cases. There were 2 relapsing cases. Conclusion The diagnosis of brucellar sacroiliitis is based mainly on the imaging results and serological testing. Respecting preventive measures is a priority in order to eradicate brucellosis. Disclosures All Authors: No reported disclosures