Abstract
BackgroundTuberculosis is the leading infectious cause of death worldwide. Among native Swiss people, tuberculosis is more common in older people than in younger people. Approximately 25–30% of reported cases of tuberculosis are purely extrapulmonary; skeletal tuberculosis is reported in 3–5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of tuberculous sacroiliitis with secondary psoas abscess, as this clinical picture is very rare.Case presentationA magnetic resonance imaging scan of an 85-year-old (Swiss-German) Caucasian woman with chronic left-sided hip pain and limitation of hip joint movement showed a progressive destruction of her sacroiliac joint and a large collection in her left iliopsoas muscle. Drainage of the abscess revealed pus; a polymerase chain reaction assay was positive for Mycobacterium tuberculosis complex. Tuberculous sacroiliitis with secondary iliopsoas abscess was diagnosed 9 months after the start of the symptoms. Combination treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was started.ConclusionsSacroiliitis with secondary psoas abscess is an unusual cause of hip pain and is likely to be overlooked since joint pain of the lower extremity and lumbar pain are some of the most common complaints in older individuals. A high level of suspicion and invasive diagnostic procedures are needed for timely diagnosis of tuberculous sacroiliitis not only in immunocompromised patients living in or originating from endemic areas.
Highlights
Tuberculosis is the leading infectious cause of death worldwide
TB in older Swiss individuals reflects widespread infection with M. tuberculosis when they were children and an increased risk of disease reactivation when the immune system weakens in old age
Skeletal TB with secondary abscess is most commonly seen in vertebral osteomyelitis, the sacroiliac joint is rarely affected
Summary
Chronic low back or hip pain should raise suspicion of TB of the spine, the ilium, or the sacroiliac joint, possibly complicated by a psoas abscess. Chronic skeletal pain with fever, weight loss, and other nonspecific symptoms should be carefully assessed in Western countries as they may be symptoms of TB. Lumbar pain and joint pain of the lower extremity are common complaints of older individuals, who are at increased risk of reactivated TB. This case report documents TB as an unusual etiology of hip pain. Our case confirms that the rarity and nonspecific clinical manifestation of infectious sacroiliitis usually lead to delayed diagnosis. AIDS: Acquired immune deficiency syndrome; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CRP: C-reactive protein; CT: Computed tomography; HIV: Human immunodeficiency virus; MDR-TB: Multidrugresistant tuberculosis; MRI: Magnetic resonance imaging; PCR: Polymerase chain reaction; TB: Tuberculosis
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