Tuberculous Sacroiliitis Research Articles

Tuberculosis of bilateral sacroiliac joints with bilateral psoas abscess: an unusual presentation

Infectious diseases usually affect the sacroiliac joint unilaterally. Out of all tuberculosis cases, bone tuberculosis is reported in 3-5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of bilateral tuberculous sacroiliitis with psoas abscess, as this clinical picture is very rare. Tuberculosis of the sacroiliac joint is often missed due to vague symptoms. More often, patients are examined in the supine position, thereby overlooking the sacroiliac joint. Involvement of the sacroiliac joint is rare, but exact numbers are not available. Our case report shows a complication of skeletal Tb that a psoas abscess may develop, causing nonspecific symptoms.

Clinical features and surgical management of tuberculous arthritis of the sacroiliac joint: a retrospective analysis of 33 patients

BackgroundWe reviewed 3 different types of tuberculous sacroiliitis via anterior and posterior approaches to determine the efficacy and safety of this surgical approach by describing clinical presentation, imaging, and surgical treatment.MethodsWe reviewed 33 patients with 3 different types of severe tuberculous sacroiliitis, of which 16 patients with anterior iliac abscess underwent anterior debridement. 17 patients underwent posterior debridement. Among them, 5 patients with lumbar tuberculosis underwent lesion debridement through fenestration, joint fusion, and interbody fusion and internal fixation. The mean postoperative follow-up was 16.9 months (12–25 months).Erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to judge the postoperative condition and functional recovery.ResultsAll patients’ hip, back and lower back pain symptoms were significantly relieved after surgical treatment. At 3 months after operation, the VAS and ODI scores of all patients decreased significantly.ConclusionSurgical treatment of tuberculous sacroiliitis should be performed as soon as possible under the adjuvant chemotherapy of anti-tuberculosis drugs. According to the different characteristics of sacroiliac joint tuberculosis, appropriate surgical operations should be adopted according to our classification criteria.

1403. Tuberculous sacroiliitis: Clinical and Imaging Characteristics

BackgroundOsteoarticular tuberculosis remains a common disease among which the spine is the most affected site. Less frequently, sacroiliac joint is involved. Its diagnosis is often delayed due to misleading and varied symptoms. The aim of this work was to study the clinical features and the contribution of imaging results in the diagnosis of tuberculous sacroiliitis.MethodsWe conducted a retrospective study including all patients hospitalized in the infectious disease department for tuberculous sacroiliitis. The diagnosis was based on clinical, laboratory and radiological features.ResultsIn total, we encountered 12 women with a median age of 51 [39-63] years. Three patients had a family history of tuberculosis (25%). The median diagnostic delay was 155 [48-331] days. The revealing symptoms were lower back pain (75%) and hip pain (25%) associated with fever (83.3%) and weight loss (75%). Reduced mobility was noted in 3 cases (25%). Pulmonary tuberculosis and tuberculous spondylodiscitis were associated with tuberculous sacroiliitis in 5 cases (41.7%) and 4 cases (33.3%), respectively. Tuberculin skin test was positive in 6 cases (50%). Laboratory investigations revealed elevated C-reactive protein levels in 11 cases (91.6%) and accelerated erythrocyte sedimentation rates in 9 cases (75%). Needle biopsy of the sacroiliac joint (41.7%) and soft tissues abscess puncture (16.6%) were performed. Computed tomography scan revealed joint space widening (83.3%), peripheral joint erosions (83.3%) and osteolysis (58.3%). Soft tissue abscesses were noted in 66.7% of the cases. Magnetic resonance imaging was performed in 4 cases (33.3%). Sacroiliac joint was hypointense in T1-weighted images (75%), hyperintense in T2 weighted images (50%) and in STIR images (50%). Bone scintigraphy, performed in 5 cases, revealed hyperfixation of the sacroiliac area (100%). All patients received antitubercular therapy. Percutaneous abscess drainage was indicated in 4 cases (33.3%).ConclusionBecause of its deep localization, the diagnosis of tuberculous sacroiliitis is mainly based on imaging results associated with epidemiological, clinical and laboratory features. Antitubercular therapy initiated promptly leads to recovery.Disclosures All Authors: No reported disclosures

Gluteus maximus abscess revealing a tuberculous arthritis: A case report and review of the literature

Although tuberculosis is a widespread disease in Morocco, musculoskeletal form is relatively rare and even rarer when affects the sacroiliac joint. Tuberculous sacroiliitis remains a challenge for orthopedists owing to its insidious onset and non-specific clinical presentation.Herein, we report the case of a 23-year-old male with a growing mass in his left gluteal area, diagnosed with tuberculous sacroiliitis, based on bacteriological and histological findings.The aim of our work is to draw attention to the importance of continued awareness for early detection and adequate treatment of this very rare entity.

Tuberculous Sacroiliitis with Secondary Psoas Abscess: A Case Report

Tuberculous sacroiliitis secondary to a psoas abscess is rare, only a few sporadic cases were reported in the literature. Tuberculous sacroiliitis is rare, usually unilateral, its symptomatology is misleading, its diagnosis is often delayed or even confused with damage to the hip or lumbosacral hinge, most often related to difficulties exploration of the sacroiliac joint. We report the case of a 66-year-old diabetic patient with low back pain, unilateral right with inflammatory appearance, insidious installation, evolving for about 8 months. The diagnosis of tuberculous sacroiliitis was made after biopsy of the sacroiliac joint. CT and MRI are necessary for lesion diagnosis. Tuberculosis treatment was started and the abscess was surgically drained. The aim of this work was to describe the diagnostic pathway of a patient with tuberculous sacroiliitis in a tropical environment. Conclusion: Tuberculous sacroiliitis, secondary to an abscess of the psoas muscle is an unusual cause of hip pain and is likely to be overlooked due to its atypical presentation.

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.

Tuberculous sacroiliitis with secondary psoas abscess in an older patient: a case report

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.

Concomitant methicillin-resistant Staphylococcus aureus infection in tubercular sacroiliitis masquerading as anti-tubercular drug resistance: Role for molecular diagnosis

A 23-year-old female on anti-tubercular therapy for tuberculous sacroiliitis presented with right sided gluteal and thigh abscess. Suspecting treatment failure, surgical evacuation of purulent material was done. The bacteriological isolation showed positivity for methicillin-resistant Staphylococcus aureus. Although the microbiological and histopathology examination of the specimen were negative for tubercular isolates, the cartridge based –nucleic acid amplification tests revealed positive genes for Mycobacterium tuberculosis and additional primers showed sensitivity for rifampicin and isoniazid. She was adequately treated with vancomycin for six weeks and anti-tubercular drugs for eight months and followed till the bony ankyloses at 18 months. This is a rare case based scenario wherein concomitant staphylococcal infection in tubercular sacroiliitis masqueraded as anti-tubercular drug resistance. The cartridge-based nucleic acid amplification test for tuberculosis is a rapid and sensitive modality in identifying mycobacteria even mixed infections and also determine drug resistance. There are fewer consensuses in the literature regarding the drugs and duration of anti-tubercular regime for tuberculous sacroiliitis with most regimes using four drugs between six to eighteen months.

Sacroiliac joint involvement in spinal tuberculosis

Background: A discussion of the incidence and pathogenesis of tuberculosis of the sacroiliac joint and a description of an association with spinal tuberculosis. Methods: A retrospective chart review was conducted in the spine unit on all inpatients admitted between 1 July 2014 and 30 June 2015. Patients with confirmed tuberculous spondylitis and/or sacroiliitis, who underwent adequate radiological examination of their sacroiliac joints, were included in the study. Available clinical and radiological investigations including plain X-rays, CT and MRI scans, were scrutinised to actively exclude sacroiliac joint involvement. Results: Sixty-six patients with tuberculous spondylitis and one patient with isolated tuberculous sacroiliitis were included in the study. Seventeen patients had multilevel (>2 levels) contiguous involvement, while 14 patients had multilevel non-contiguous lesions. Thirty-four patients had associated iliopsoas abscesses. Thirteen patients (19.4%) were identified as having involvement of their sacroiliac joint(s). Six had bilateral involvement, five with right-sided and two patients with left-sided involvement. Eleven of the patients identified had associated iliopsoas abscesses, two of whom had gluteal and iliopsoas abscesses. The patient with isolated sacroiliac joint involvement had a gluteal abscess. Conclusion: Concurrent radiographic evidence of sacroiliac joint involvement is not uncommon in patients with spinal tuberculosis, more so when abscess formation is associated, and should be actively looked for and excluded in such cases. Level of evidence: Level 4

A rare case report at rare site tuberculosis of sacrum sacroiliac joint with gluteal abscess indication for drainage of cold abscess which usually treated by conservative treatment

Introduction: Tuberculosis remains a major public problem for the developing countries. Osteoarticular tuberculosis represents 2% to 5% of all cases of tuberculosis, in that the sacroiliac joint is involved in 3–9.7%. Isolated tuberculosis of the sacrum is rarely reported; with Sacroiliac joint infections represent a diagnostic dilemma for their vague and non-specific clinical presentation. Case report: A 26 yr Female presented with Pain, Swelling over left Buttock since 2 month with Low Backache, Limping was present with Constitutional symptom Loss of Appetite, Low grade Fever, Weight Loss. Patient was investigated then planned for surgery incision and drainage curettage was done and sends for biopsy. After laboratory tests diagnosed Tuberculosis Osteomyelitis and after proper duration of ATT drugs patient was cured. Conclusion: So it is rare case at rare site Sacrum with reactionary Sacroiliac joint Tuberculosis with Gluteal Abscess. Clinical diagnosis of sacroiliac joint infection includes a thorough history and a meticulous examination of the lower back and the sacroiliac joint. Tuberculous sacroiliitis should be differentiated with various disorders. After confirmation of diagnosis with support of clinical features blood report biopsy ATT drugs given with proper duration and doses in Follow up serial x rays and bloods test was done. The prognosis of sacral tuberculosis is good, if a rapid and correct diagnosis is made and adequate treatment is provided with proper duration and drugs doses Indication of drainage of cold abscess was because It large volume which cannot treated conservatively, pressure effect causing severe pain, difficulty in sitting, definitive diagnosis of Infective Pathology.

The efficacy of negative pressure wound therapy in treating sacroiliac joint tuberculosis with a chronic sinus tract: a case series.

ObjectiveTuberculous sacroiliitis with abscess accounts for approximately 50 % of all sacroiliac joint tuberculosis cases. Tuberculous abscesses spread into the sacroiliac joint capsule, subcutaneous tissue, and the skin, and finally becomes a skin sinus. As there are no previous reports about sacroiliac joint tuberculosis with a chronic sinus, we evaluated its clinical characteristics and management by negative pressure wound therapy.MethodsA retrospective analysis of 12 patients with sacroiliac joint tuberculosis with chronic sinuses treated between January 2005 and January 2010 was conducted. Patients were treated with negative pressure wound therapy (NPWT). Treatment was divided into three phases: control phase, standard dressing changes daily for 4 weeks; interphase washout period, dressing changes every 3 days for 1 week; and intervention phase, no dressing changes until minimal sinus tract drainage (<5 ml per 24 h). Outcomes including the sinus healing time and the drainage volume were evaluated.ResultsThe mean follow-up was 37.1 months. Sinus healing was observed at an average of 25.25 ± 7.23 (range, 20–42) days after initial treatment. The mean volume of drainage did not change during the control phase, but decreased from 29.17 ± 16.63 to 0.25 ± 0.87 ml in the intervention phase. The mean daily reduction of wound volume, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the intervention phase was greater than in the control phase (P < 0.05). Anti-tubercular therapy was administered an average of 14.00 ± 2.95 (range, 12–18) months. ESR and CRP returned to normal within 3 months after the sinus closure. Bony fusion was observed in 5 (41.7 %) patients, and fibrous ankylosis in the other patients at last follow-up. All patients healed uneventfully.ConclusionsEarly diagnosis of sacroiliac joint tuberculosis with a chronic sinus can be difficult. NPWT provides better healing of sacroiliac joint tuberculosis with a chronic sinus than standard dressing changes.

Tuberculous Sacroiliitis: A Study of the Diagnosis, Therapy and Medium-Term Results of 15 Cases

This report reviews the diagnosis, treatment and follow-up of 15 Chinese patients with tuberculous sacroiliitis (TBS) from 1997 to 2007. Buttock pain and lower back pain were the main complaints. All patients received antituberculosis chemotherapy treatment for at least 18 months; 10 also underwent surgery, with seven undergoing modified Smith-Petersen arthrodesis (evaluated using a visual analogue scale [VAS] for pain and the Oswestry Disability Index [ODI]). No simplex tuberculous synovitis existed at diagnosis. Bone-marrow oedema, cold abscess and soft-tissue oedema responded to antituberculosis treatment. Thirteen patients (86.7%) had satisfactory outcomes. There were also significant improvements in VAS and ODI scores post-operatively. In the chemotherapy plus surgery group, eight patients had solid bony fusions at 24 months post-operatively, while the five on chemotherapy alone presented with fibrous ankylosis at 24 months. Chemotherapy is the main treatment for TBS and modified arthrodesis is a feasible and effective method for treating severe joint destruction.

Tuberculous sacroiliitis in Chinese patients: Case studies on the diagnosis, treatments and medium-term follow-up

Tuberculous sacroiliitis in Chinese patients: Case studies on the diagnosis, treatments and medium-term follow-up

Unilaterale Sakroiliitis bei tuberkulösem Multiorganbefall

A tight but painless soft-tissue swelling in the left parasternal region, with chronic cough and lumbo-ischial pain becoming progressively more severe over several months, occurred in a 27-year-old man. The chest X-ray film was normal, radiography of the iliosacral joints revealed right-sided sacroiliitis. In the further course of the illness night sweat, nightly fever up to 38 degrees C and weight loss of 7 kg in two months, as well as severe treatment-resistant earache developed. When hospitalized, another chest X-ray film showed disseminated small nodular foci pointing to tuberculosis. Sputum and irrigation fluid from the right middle-ear contained Mycobacterium tuberculosis. Biopsy material from the parasternal tumour and middle-ear mucosa contained caseous granulomas, confirming the diagnosis of tuberculous sacroiliitis as part of multi-organ tuberculosis. Tuberculostatic treatment--400 mg isoniazid, 600 mg rifampicin, and 1,500 mg pyrazinamide daily (the latter discontinued after 8 weeks)--normalized the appearance in the chest X-ray film. The patient returned to his home in Holland and, four years later, reported that he was free of any symptoms, even during sport activity.

Sacro-iliites tuberculeuses : à propos de 22 cas

Despite their relative rarity, increased awareness of tuberculous sacro-iliitis is necessary. Indeed, diagnosis is usually delayed, because of the non specific clinical features and the difficulty to explore the sacro-iliac joint. To study the characteristics of sacro-iliac joint tuberculosis. A retrospective study of 22 cases of tuberculous sacro-iliitis collected between 1987 and 2003 in four university hospital centres. All our patients were explored clinically and radiologically. Microbiology, biochemical and serologic tests were also performed. 13 cases were confirmed bacteriologically or histologically and for the remaining nine cases evidence of tuberculous sacroiliitis was based on clinical, biological, radiological features and outcome on treatment. Inflammatory pain was present in almost all cases, and a collected abscess in 11 cases. Standard radiographs were also in all cases and ultrasound and CT scan showed an abscess in 8 patients. The average duration of treatment was nine months. The outcome was excellent in the majority of cases. Sacro-iliac joint is difficult to explore and has recently beneficiated of technical improvement in imaging and diagnostic. Medical treatment of tuberculosis sacro-iliitis is often sufficient.

Tuberculous sacroiliitis. Four cases

Tuberculous sacroiliitis with no local abscesses or tuberculosis at other sites occurred in four patients, three men and one woman with a mean age of 42 years. Slow progression characterized this uncommon variant of joint tuberculosis. Two patients reported contact with family members known to have tuberculosis. Mean time from symptom onset to presentation was 14 months. Surgical biopsy showed epithelioid and giant-cell granulomas with caseous necrosis; culturing on Lowenstein–Jensen medium recovered the tubercle bacillus. Treatment was with antitubercular drugs, and protection from weight bearing for 4 weeks. These four cases illustrate the slowly progressive course of the clinical and radiological manifestations and underline the diagnostic difficulties met in the early stages of tuberculous sacroiliitis without tuberculosis at other sites. Antitubercular treatment can restore joint function provided the diagnosis is made before radiological destruction occurs.

Les sacro-iliites tuberculeuses (quatre cas)

Tuberculous sacroiliitis with no local abscesses or tuberculosis at other sites occurred in four patients, three men and one woman with a mean age of 42 years. Slow progression characterized this uncommon variant of joint tuberculosis. Two patients reported contact with family members known to have tuberculosis. Mean time from symptom onset to presentation was 14 months. Surgical biopsy showed epithelioid and giant-cell granulomas with caseous necrosis; culturing on Lowenstein–Jensen medium recovered the tubercle bacillus. Treatment was with antitubercular drugs, and protection from weight bearing for 4 weeks. These four cases illustrate the slow progressive course of the clinical and radiological manifestations and underline the diagnostic difficulties met in the early stages of tuberculous sacroiliitis without tuberculosis at other sites. Antitubercular treatment can restore joint function provided the diagnosis is made before radiological destruction occurs.

Sacroiliac Joint Tuberculosis

The authors treated 16 patients with tuberculosis of the sacroiliac joint. Twelve were treated surgically and four were treated conservatively. The clinical symptoms were buttock and low back pain in all patients, and most had difficulty walking (68.6%) and had radicular pain in their lower limbs (50%). Of the 16 patients, four (15%) had associated tuberculous spondylitis, six (37.5%) had an abscess in the gluteal region, and two (12.5%) had an abscess in the inguinal region. The diagnosis was proven by pathologic specimen in 12 patients and by clinical symptoms, laboratory data, and radiologic findings in the remaining four patients. The authors classified tuberculous sacroiliitis into four types based on the clinical and radiologic findings. Types 1 and 2 were treated conservatively with chemotherapy alone, whereas Types 3 and 4 were treated with surgery and chemotherapy. Healing occurred and was evident in patients who had curettage and arthrodesis (Types 3 and 4) at a mean of 20.8 months, which was comparable with healing in the patients who had chemotherapy alone that occurred at a mean of 23.5 months (Types 1 and 2). The authors suggest that the new classification will be helpful in determining the therapeutic plan of tuberculous sacroiliitis.

結核性仙腸関節炎の１症例

We experienced a case of tuberculous sacroiliitis. The patient was a 70-year-old woman. She suffered from general fatigue and febrile, but complained of no pain of the sacroiliac (SI) joint. She had slight tenderness over the right SI joint. Gaenslen test was negative. Roentgenogram revealed diffuse destruction with calcificated masses on the right SI joint. Laboratory on admittance showed no leukocytosis, elevation of erythrocyte sedimentation rate (125mm/hr) and C-reactive protein (3.79mg/dl). Results of the Mantoux test were positive. Needle biopsy from the right SI joint was performed, but the culture of specimens was negative and the pathological findings were not the specific results. We performed curettage and irrigation, and got the specimen of the bone involved. Histologic examination revealed granulomatous inflammation with infiltration of epitheloid cells, tubercle formation, caseous necrosis, and Langhans' giant cells. She was treated with three combined antituberculosis drugs (isoniazid, ethambutol, and rifampicin). At present 6 months after surgery, she has no pain, no fever and feels no fatigue.Sacroiliac joint involvement has been reported in 3-10 percent of patients with skeletal tuberculosis. Lack of awareness of this rare disease now often leads to diagnotic delay and increased morbidity. The direct sampling of the SI joint is necessary to establish the diagnosis. It is important to obtain the specimen involving oteoarticular fragments for the diagnosis.

Sacroiliites infectieuses non tuberculeuses. Manifestations cliniques et intérêt diagnostique de la ponction-biopsie sacroiliaque au trocart chez 18 patients

We report a series of 18 patients with non tuberculous pyogenic sacroiliitis. All patients presented with unilateral buttock pain associated with fever. Pelvic radiographs, CT and bone scan were diagnostic of sacroiliac joint disorder. We emphasize the usefulness of the sacroiliac joint needle biopsy which permitted the bacteriological diagnosis in 13 out of 18 patients.