Pyogenic Sacroiliitis Research Articles

Disseminated staphylococcal infection (involving bilateral sacroiliac joints and sternoclavicular joint) in a hemodialysis patient

Pyogenic sacroiliitis is a rare infection and has not been reported in a hemodialysis patient. We report a case of disseminated staphylococcal infection with bilateral sacroiliitis, sternoclavicular arthritis and right sternocleidomastoid abscess in a dialysis patient. Prompt diagnosis and institution of antibiotics resulted in complete recovery.

Pyogenic sacroiliitis caused by Salmonella schwarzengrund in a young healthy woman: a case report and literature review

BackgroundSalmonella species are a leading cause of diarrheal diseases worldwide. Recent epidemiological studies have shown that Salmonella schwarzengrund (S. schwarzengrund) is highly prevalent in various regions. Herein, we report that S. schwarzengrund caused sacroiliac joint (SIJ) infection with septic shock in a young woman, although she was immunocompetent.Case presentationA 20-year-old woman presented with left hip pain, accompanied by vasopressor-requiring hypotension. Her imaging examinations showed fluid collection in her SIJ and a small abscess in the left iliac muscle. Later, the blood and aspiration fluid culture and genetic analysis revealed the presence of S. schwarzengrund. We diagnosed sacroiliac joint (SIJ) infection with septic shock caused by S. schwarzengrund. Her condition improved after performing several interventional radiology (IVR) procedures for SIJ abscesses and providing appropriate antibiotic treatment. Finally, she was discharged without any sequelae. Screening tests and genetic analysis about her immunodeficiency did not indicate a congenital disorder.ConclusionThese clinical courses indicate that S. schwarzengrund could cause the fatal SIJ infection irrespective of the host immunocompetence. Considering the recent increase in the diagnostic rate of S. schwarzengrund, this case emphasized the need to be more cautious about Salmonella species infection.

Acute Pyogenic Sacroiliitis: Brucellosis and Early Diagnosis

Acute pyogenic sacroiliitis is an uncommon condition caused by multiple infectious agents, and a few cases are reported to be caused by brucella species. We present the case of a 20-years-old woman who developed afebrile low back pain of sudden onset, few weeks after the ingestion of unpasteurized milk. Thorough physical examinations with provocative tests were done. Suspected acute sacroiliitis and the brucella etiology were addressed by serological tests completed by multiple

Perinatal Sacroiliitis Diagnostic Challenges: A Case Report

Background: Lumbo-pelvic (LPP) pain is common and non specific problem during pregnancy and post partum. Despite the fact that perinatal pyogenic sacroiliitis (PSI) during this period is rare, it should be considered as a vital differential diagnosis in women who have debilitating lower back and pelvic girdle pain. Case: A 34 years old primigravida presented to the emergency department with extreme right sided lower back pain radiating to the right gluteal region and down to the back of the right thigh. This pain began twelve days prior to her presentation and eventually worsened to the point that she couldn't stand or walk. Her vital signs were within normal limits, and she was febrile. Apart from a slight widening of the symphysis pubis, her pelvic and lumbo-sacral plain x-rays revealed no important findings. With the clinical impression of right LPP, the patient was admitted for pain management and further inquiries. Conclusion: Despite the fact that lower back and pelvic girdle pain are normal throughout pregnancy and the postpartum period, perinatal PSI is uncommon. It's a tough diagnosis to make because the symptoms and signs aren't clear, and the tests aren't definitive. When pathognomonic clinical and radiologic signs indicate an infectious process and isolation of pathogenic bacteria is not possible, medical management with empirical antibiotics should not be delayed.

Pyogenic sacroiliitis in the immediate postpartum period: a case report and review of literature

Pyogenic sacroiliitis in the immediate postpartum period is an extremely rare orthopaedic emergency which requires prompt diagnosis and treatment to avoid permanent destruction of the sacroiliac joints. Herein we report a case of pyogenic sacroiliitis in the immediate postpartum period of a 25-year old woman presenting with acute onset severe lower back pain, buttock pain and inability to move her right lower limb. Prompt suspicion and imaging facilitated the diagnosis of pyogenic sacroiliitis for which she was treated with antibiotics and her pelvic joints were supported with a corset around the hip and traction applied to the right leg.

Clinical and imaging characteristics of 110 patients with infectious sacroiliitis

Objective: To investigate the clinical and imaging characteristics of infectious sacroiliitis. Methods: A total of 110 patients diagnosed with infectious sacroiliitis were retrospectively analyzed between 2008 and 2017.Clinical manifestations and therapeutic responses, laboratory tests such as HLA-B(27), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), T cell spot test for tuberculosis infection(TB-SPOT), Brucella agglutination test ect., blood culture of pathogens, pathological findings as well as magnetic resonance imaging were all recorded and analyzed. Results: Among the 110 patients, the male to female ratio was 44 to 66 with an average age 15-58(29.4±10.8) years and the course of disease 0.3-60 (5.7±13.2) months. As to the pathogens, 71 cases were pyogenic, 24 cases with tuberculous sacroiliitis, and 15 cases were brucellosis infections. The majority of patients (97.3%) had unilateral sacroiliac joint involvement. Ten (9.1%) patients suffered infectious sacroiliac arthritis after delivery. Hip pain was the main clinical manifestation (83/110,75.5%) and fever as the second (77/110,70.0%). HLA-B(27) was positive in 11 patients (10.0%). Both ESR and CRP were elevated in the majority. There were 103 patients receiving sacroiliac joint puncture biopsy. Seven patients were diagnosed through blood culture or brucellosis agglutination test. Bone marrow edema and osteolytic lesions in magnetic resonance imaging (MRI) were more common in pyogenic or tuberculous sacroiliitis than in brucellosis infections. Conclusion: Infectious sacroiliitis should be differentiated from spondyloarthritis, which develops more in female patients, with short disease duration and fever, mostlynegative HLA-B(27). The majority patients present unilateral sacroiliitis. Active inflammatory lesions are usually beyond sacroiliac joints with osteolytic changes in MRI examinations.

Pyogenic sacroiliitis in children: don't forget the very young.

Pyogenic sacroiliitis (PS) is rare with less than 100 pediatric cases reported in the medical literature. To better characterize PS in the pediatric population, we investigated a series of children presenting with PS. Retrospective data analysis was done at an academic tertiary center between the years of 2000 and 2017. All hospitalized children ≤ 16years of age with PS were evaluated. Of the 894 children hospitalized with osteoarticular infections, 18 were diagnosed with PS (2%) and are included in the review. Two clinically distinct groups were identified. PS in infants (n = 13, 72.2%, mean age 1.1years) had an indolent course and a faster recovery without any bacterial source identified. In contrast, the group of older children (n = 5, 27.8%, mean age 11.6years) had a more complicated course and a higher rate of identified bacterial infections.Conclusion: We describe an under-recognized entity of PS in infants with a mild clinical course and fast recovery that differ from the "classical" septic sacroiliitis. Infants with PS did not suffer from invasive complications, and pathogen characteristics of older children were not identified. Infants with fever, irritability, decreased range of motion in the pelvic area, and pain during diapering should alert the clinician to this diagnosis. What is Known: • Pediatric pyogenic sacroiliitis is an extremely rare condition usually caused by Staphylococcus aureus with highest incidence in adolescents. • The diagnosis of PS is challenging due to its rarity and difficulty in assessing the sacroiliac joint. What is New: • We describe an under-recognized entity of PS in infants with a mild clinical course, without invasive complications and with fast recovery that differ from "classical" septic sacroiliitis. • Infants with fever, irritability, decreased range of motion in the pelvic area and pain during diapering should raise clinical suspicion of this diagnosis.

PEDIATRIC PYOGENIC SACROILIITIS: A RARE CASE REPORT

Introduction: Pyogenic sacroiliitis accounts for 12% of all cases of septic arthritis with less than 200 cases reported in the English literature since the beginning of the twentieth century. Considerable delay between presentation and diagnosis is seen because of unusual presentation and diagnostic dilemma. Cultures of joint fluid usually grow Staphylococcus aureus. Magnetic resonance imaging has been found to be the most useful imaging modality in diagnosis. Being very uncommon disease in children, the key to successful management is early diagnosis in which computed tomography (CT), bone scans, and magnetic resonance imaging (MRI) findings play a crucial role. If the diagnosis is established promptly, most patients can be managed successfully with antimicrobial therapy with excellent prognosis. Most reported cases required prolonged antimicrobial therapy of six to nine weeks. Presented here is a child with pyogenic sacroiliitis managed at our hospital (Universal College of Medical Sciences Teaching Hospital-UCMSTH) and review of the literature on this relatively rare diagnosis. Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 62-65

Pediatric Sacroiliitis: Clinical and Microbiologic Differences Between Infants and Children-Adolescents.

The aim of this study was to improve knowledge of pediatric pyogenic sacroiliitis (PSI) in the pediatric population based on a consecutive case series. We conducted a single-center cross-sectional study on 16 patients admitted to the emergency department of our Hospital between January 1990 and December 2015 with a confirmed diagnosis of PSI. The patients were divided into 2 groups by age: infants (6 months to 4 years) and children-adolescents (4-16 years). The features of PSI, clinical signs and symptoms, laboratory tests, bacteriologic investigations, radiologic examinations and outcome were compared among the 2 groups. Patients in the children-adolescent group usually presented with a history of limping and buttock or lower back pain, and methicillin-susceptible Staphylococcus aureus was the most frequent pathogen. We observed a second peak of incidence of PSI in infants with consistent difference in clinical and microbiologic presentation. Infants were more likely to have an ambiguous onset with the refusal to bear weight as the only consistent clinical manifestations, and biologic investigations demonstrated higher erythrocyte sedimentation rate and platelet counts. However, all blood and joint fluid cultures were sterile in the infant group. PSI in infants and adolescents may represent 2 different conditions. Although PSI is mainly caused by S. aureus in the children-adolescent group, clinical manifestations and biologic characteristics of PSI in infants suggest Kingella kingae as the etiology osteoarticular infection. Thus, oropharyngeal swab polymerase chain reaction assay for K. kingae and magnetic resonance imaging should be considered for early diagnosis and treatment of this condition in the younger age group.

Valeur ajoutée d’une acquisition TEMP/TDM centrée sur le bassin complétant une scintigraphie osseuse dans un cas de sacroiliite à pyogène

Pyogenic sacroiliitis is a rare entity, which occurs most often in children and young adults. The diversity of clinical presentation makes the diagnosis difficult and delays the prescription of appropriate treatment. The psoas muscle abscess is a rare complication of infectious sacroiliitis. Herein, we report the case of a 47-years-old patient, complaining of low back pain with psoitis and fever, lasting for 12 days. Planar bone scan and SPECT/CT acquisitions were totally contributive by the visualization of the sacroiliac joint damage and a psoas abscess missed on the initial CT. The bacteriological proof has been provided by the direct examination and culture of the drainage abscess fluid.

Acute sacroiliitis.

The purpose of this study was to review the data on the etiology, risk factors, clinical presentations, and diagnosis of acute sacroiliitis. A Pubmed search utilizing the indexing term "acute sacroiliitis" was conducted and the data pertinent to the aim of the review was extracted and organized in accordance with the preplanned structure of the manuscript. The diagnosis of acute sacroiliitis is often challenging because of both the relative rarity of this presentation and diverse character of acute sacroiliac pain, frequently mimicking other, more prevalent disorders. Technetium bone scintigraphy can localize the disease process to the sacroiliac joint, while computed tomography or magnetic resonance imaging can be used for the detailed characterization and the extent of the disease as well as the diagnosis of complications. Pyogenic sacroiliitis is by far the most common cause of acute sacroiliitis. Brucellosis, acute sacroiliitis in the course of reactive arthritis, and crystalline-induced sacroiliitis frequently imitate pyogenic sacroiliitis. Acute sacroiliitis can rarely be also related to hematological malignancies or treatment with isotretinoin. Awareness to the possibility of acute sacroiliitis and a thorough physical examination are the necessary prerequisites to its timely diagnosis, while the appropriate laboratory and imaging studies should confirm the precise diagnosis and direct the appropriate treatment strategy.

Infectious sacroiliitis in tunisian centre: retrospective study of 25 cases

Les sacroiliites infectieuses sont rares mais peuvent se compliquer de séquelles fonctionnelles invalidantes. Décrire les caractéristiques cliniques et bactériologiques des sacroiliites infectieuses chez les patients suivis à Sousse, Centre Tunisien. Etude rétrospective, descriptive, des cas de sacroiliites infectieuses chez les patients hospitalisés à Sousse entre 2000 et 2015. Le diagnostic a été retenu devant des signes cliniques, d'imagerie, et microbiologiques évocateurs. Vingt-cinq patients, 10 hommes et 15 femmes, d’âge moyen 41 ans (19-78) ont été inclus. Les sacroiliites étaient dues à des bactéries pyogènes dans 14 cas (56%), brucelliennes dans 6 cas (24%), et tuberculeuses dans 5 cas (20%). La durée moyenne d’évolution était de 61, 45 et 402 jours respectivement. Les signes cliniques les plus fréquents étaient les douleurs fessières (92%) et la fièvre (88%). La radiographie standard était anormale dans 75% des cas. La TDM et l'IRM sacro-iliaques dans tous les cas. Le diagnostic a été confirmé bactériologiquement dans 24 cas (96%). La durée moyenne d'antibiothérapie était de 83 jours dans les sacroiliites à pyogènes, et de 102 jours dans les SI brucelliennes. L’évolution était favorable chez 12 patients (48%), 9 patients (36%) ont gardé une douleur sacro-iliaque séquellaire, et 4 patients (16%) sont décédés. Dans notre étude, la durée d’évolution de la sacroiliite infectieuse ne permettait pas de prédire la bactérie responsable, d'où la nécessité d'obtenir une documentation bactériologique afin de prescrire une antibiothérapie appropriée.

Piriformis muscle abscess associated with pyogenic sacroiliitis

Pyogenic sacroiliitis is a relatively rare cause of hip pai n and fever. Psoas muscle abscess complicating pyogenic sacroiliitis, has been reported in some cases; however, pir iformis muscle abscess causing sacroiliitis has never been described. We report a 14-year-old girl who developed a piriformis muscle abscess associated with pyogenic sacroiliitis due to met hicillin- sensitive Staphylococcus aureus.

Postpartum pyogenic sacroiliitis with methicillin-resistant Staphylococcus aureus in a healthy adult: A case report and review of the literature

ObjectiveBack and buttock pain during pregnancy and the postpartum period generally improves spontaneously and rarely causes problems. However, such pain is infrequently induced by pyogenic sacroiliitis. Case reportWe herein present a 37-year-old female patient with no previous medical history who developed pyogenic sacroiliitis with severe right buttock pain 7 days after cesarean delivery. Arthrocentesis was performed, and a culture revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA). After 6 weeks of treatment with intravenous antibiotics, her infection became quiescent. Eight cases of pyogenic sacroiliitis during the postpartum period and seven cases during pregnancy have been reported, but most of the causative pathogens were methicillin-sensitive Staphylococcus or Streptococcus species. ConclusionThis report describes the first case of postpartum pyogenic sacroiliitis caused by MRSA. The frequency of infection with MRSA has recently increased, and community-acquired MRSA, which affects even healthy young people, has also become a problem. Antibiotics for empirical therapy after a diagnosis of pyogenic sacroiliitis, including anti-MRSA antibiotics, should be carefully selected.

Erratum: A Case of Acute Pyogenic Sacroiliitis and Bacteremia Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus

[This corrects the article on p. 441 in vol. 45, PMID: 24475359.].

Pyogenic sacroiliitis: diagnosis, management and clinical outcome

The purpose of the present study was to evaluate the role of diagnostic tools and management options for patients with pyogenic sacroiliitis, including potential complications. This retrospective study included 16 patients with pyogenic sacroiliitis who were admitted to a single orthopaedic centre between 2007 and 2012. The following data were collected: demographics, history, radiography, magnetic resonance images (MRI), biological data, type of pathogenic agent, abscess formation, type of management, and clinical outcome. Our study demonstrated that only one-fifth of the patients with lumbogluteal or hip pain had established diagnoses of suspected pyogenic sacroiliitis upon admission. MRIs confirmed this diagnosis in all cases. MRI examinations revealed joint fluid in the sacroiliac joint and significant oedema of the adjacent bone and soft tissues. In 12 of the 16 cases, erosions of the subchondral bone were encountered. Contrast-enhanced MRI revealed that 9 patients had abscesses. All patients received antibiotic therapy. Antibiotic treatment was only successful in 9 cases. The other 7 patients underwent computed tomography (CT)-guided abscess drainage. Drainage was sufficient for 4 patients, but 3 patients required open surgery. One patient required sacroiliac arthrodesis. The clinical outcomes included minimal disability (n = 10), moderate disability (n = 5), and full disability (n = 1) of the spine. Contrast-enhanced MRI is mandatory for a reliable diagnosis. Abscess formation was observed in approximately half of the MRI-diagnosed sacroiliitis cases and required minimally invasive drainage under CT guidance or frequently open surgery.

A challenging case of septic sacroiliitis with psoas involvement

Objective and importance: We report on a rare case of septic arthritis of the sacroiliac joint in a young patient without apparent predisposing factors.Clinical presentation: A 22-year-old female presented with severe right pelvic and gluteal pain and systemic illness. She had a recent diagnosis of bilateral sacroiliitis.Intervention: Systemic illness quickly subsided after initiation of intravenous antibiotic treatment. Subsequently, gluteal pain gradually diminished.Conclusion: Pyogenic sacroiliitis should be taken into account in patients with sacroiliitis and fever onset. Magnetic resonance imaging shows signal anomalies well beyond disappearance of symptoms, which may or may not require prolonged antibiotic therapy.

Pyogenic Sacroiliitis in Children: Report of Two Cases and Literature Review

Pyogenic sacroiliitis in children is a relatively rare condition that presents a diagnostic challenge for clinicians. Early diagnosis on the basis of clinical and laboratory findings plays a crucial role for successful treatment. We report two children diagnosed with pyogenic sacroiliitis who were successfully treated with prompt antibiotics without sequelae.

Pyogenic sacroiliitis and pyomyositis in a patient with systemic lupus erythematous.

Pyogenic sacroiliitis and pyomyositis are uncommon infectious diseases and their diagnoses are often delayed. They are typically seen in children and young adults and are rare in middle-aged people especially in those affected by rheumatic diseases. We present the first case of a Staphylococcus aureus related pyogenic sacroiliitis associated with iliacus and gluteal pyomyositis occurring in a patient with systemic lupus erythematosus. Antibiotic treatment was administered for a total of 6 weeks with a total recovery. Pyogenic sacroiliitis and pyomyositis, although remaining rare events, should be remembered as severe complications in immunosuppressed patients with inflammatory diseases. Early clinical suspicion, imaging diagnosis, and adequate therapy are decisive for the satisfactory outcome.

Postpartum Enterobacter Pyogenic Sacroiliitis: A Case Report and Literature Review.

Postpartum pyogenic sacroiliitis is a rare condition. Accurate diagnosis is frequently delayed because of poor localization of initial symptoms and the rarity of this disorder. Pyogenic sacroiliitis has been related to trauma, intravenous drug abuse, and gynecological infections1-3, but it is rare without a predisposing factor. We report the case of a thirty-one-year-old woman with postpartum pyogenic sacroiliitis caused by the Enterobacter species, and we also provide a review of the pertinent literature. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A thirty-one-year-old woman (gravida 4, para 4) presented to our emergency department with symptoms of fever and pain in the right buttock for three days. The pain had begun two hours after a normal vaginal delivery. The past medical history noted sclerotherapy for varicose veins on both lower extremities two years earlier. The patient denied any recent history of intramuscular drug injection. Vital signs included a temperature of 38.8°C and a pulse rate of 99. On physical examination, there was limitation of right hip motion and a positive test for flexion, abduction, and external rotation (FABER). The right leg had normal muscle strength, with no swelling, warmth, or erythema. Laboratory studies, including complete blood-cell count as well as kidney and liver function tests, were normal except for leukocytosis (white blood-cell count: 14 × 109/L; lymphocytes: 9%; neutrophils: 84%), an elevated C-reactive protein level of 132 mg/L (normal, less than 5 mg/L), and an elevated erythrocyte sedimentation rate of 110 mm/h (normal, 0 to 15 mm/h). The urinalysis and the subsequent urine culture specimen were negative. The rose bengal test for Brucella was also negative. The patient was admitted to the hospital with a diagnosis of postpartum pyrexia and was administered ceftriaxone (1 gm …