Postpartum Infectious Sacroiliitis Temporally-Related to Continuous Labor Epidural Analgesia: Was the Epidural to Blame? A Case Report and Review of the Literature

Basta Mafdy

doi:10.23937/2377-4630/1410102

Abstract

Infectious (bacterial) sacroiliitis, though rare, yet needs to be considered at the differential diagnosis of back/leg pain in parturients. The following is a case of infectious sacroiliitis in a postpartum patient that presented four days after delivery with hip and leg pain. Interestingly, the patient's labor analgesia was conducted with a continuous lumbar epidural analgesia; however, a causal relationship remains to be determined.

Highlights

WBCs: White Blood Cells; ED: Emergency Department; lower extremity (LE): Lower Extremity; SI: Sacroiliac; magnetic resonance imaging (MRI): Magnetic Resonance Imaging; inflammatory sacroiliitis (ISI): Infectious Sacroiliitis; computerized tomography (CT): Computerized Tomography; erythrocyte sedimentation rate (ESR): Erythrocyte Sedimentation Rate; C-reactive protein (CRP): C Reactive Protein
On postpartum day 1, the patient started to complain of sharp pain in the left hip and gluteal regions with radiation down the left leg that, after evaluation, was attributed to possible entrapment neuropathy encountered during labor
On postpartum day 4, the patient presented to the Emergency Department (ED) with worsening left hip and left leg pain that persisted since her vaginal delivery

Summary

List of Abbreviations

WBCs: White Blood Cells; ED: Emergency Department; LE: Lower Extremity; SI: Sacroiliac; MRI: Magnetic Resonance Imaging; ISI: Infectious Sacroiliitis; CT: Computerized Tomography; ESR: Erythrocyte Sedimentation Rate; CRP: C Reactive Protein. On postpartum day 1, the patient started to complain of sharp pain in the left hip and gluteal regions with radiation down the left leg that, after evaluation, was attributed to possible entrapment neuropathy encountered during labor. The patient was discharged home on postpartum day 2 after some improvement at her hip and leg pain and instructed to follow up as scheduled. On postpartum day 4, the patient presented to the Emergency Department (ED) with worsening left hip and left leg pain that persisted since her vaginal delivery. An orthopedic consult for septic arthritis was placed, but conservative management was recommended in light of clinical (decreasing pain), and laboratory (resolving leukocytosis, decreasing ESR and CRP) improvement. The patient was discharged home on long term (6 weeks) intravenous antibiotics and recommended to follow up as instructed

Discussion

Conclusion