Subscribe to RSS
Download PDF
DOI: 10.1055/s-0042-1746201
Infectious Sacroiliitis Secondary to an Iliopsoas Abscess – A Case Report
Article in several languages: español | English
Abstract
Infectious sacroiliitis (ISI), also described in the literature as septic or pyogenic sacroiliitis, is an infrequent pathology, and its diagnosis constitutes a challenge due to its relative rarity and the diverse clinical presentation, frequently imitating other more prevalent disorders originating in neighboring structures.
A high index of suspicion and a thorough physical examination are required in order to establish an opportune diagnosis, while laboratory and imaging studies help confirm the diagnosis and direct the appropriate treatment strategy to avoid complications and sequelae in the short and medium terms.
We herein present a case of a female patient aged 36 years, with a clinical picture of left ISI, secondary to an iliopsoas muscle abscess, a condition that usually presents as a complication of the infection. The clinical, imaging and microbiological diagnoses were made, the timely antibiotic treatment was initiated, and an excellent clinical evolution without sequelae was achieved.
Level of evidence IV.
Disclaimer
The opinions expressed in the present article are exclusively the responsibility of the authors, and do not correspond to an official position of the institution.
Publication History
Received: 21 August 2020
Accepted: 04 February 2021
Article published online:
20 May 2022
© 2022. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referencias
- 1 Diacinti D, Gioia C, Vullo F, Cannavale G, Catalano C, Valesini G. Magnetic resonance imaging findings of infectious sacroiliitis associated with iliopsoas abscess: a case report in a young male. Reumatismo 2018; 70 (04) 264-267
- 2 Kucera T, Brtkova J, Sponer P. et al. Pyogenic sacroiliitis: diagnosis, management and clinical outcome. Skeletal Radiol 2015; 44 (01) 63-71
- 3 Doita M, Yoshiya S, Nabeshima Y. et al. Acute pyogenic sacroiliitis without predisposing conditions. Spine 2003; 28 (18) E384-E389
- 4 Vinceneux P, Rist S, Bosquet A. Arthrites septiques des sacroiliaques et de la symphyse pubienne. Rev Rhum 2006; 73: 177-182
- 5 Muche B, Bollow M, François RJ, Sieper J, Hamm B, Braun J. Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum 2003; 48 (05) 1374-1384
- 6 Canella C, Schau B, Ribeiro E, Sbaffi B, Marchiori E. MRI in seronegative spondyloarthritis: imaging features and differential diagnosis in the spine and sacroiliac joints. AJR Am J Roentgenol 2013; 200 (01) 149-157
- 7 Pertuiset É. Les autres causes de sacroiliites que les spondylarthropathies. Rev Rhum 2009; 76: 761-766
- 8 Osman AA, Govender S. Septic sacroiliitis. Clin Orthop Relat Res 1995; (313) 214-219
- 9 Ghosh S, Narang H, Goel P, Kumar P, Soneja M, Biswas A. Atypical presentation of pyogenic iliopsoas abscess in two cases. Drug Discov Ther 2018; 12 (01) 47-50
- 10 Barnes M, Bush C, Jones J. Pyogenic sacroiliitis: A rare complication of inflammatory bowel disease. Am J Emerg Med 2019; 37 (07) 1395.e1-1395.e2
- 11 Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician 2014; 89 (01) 27-34
- 12 Berthelot J, Laslett M. Par quels signes cliniques s'assurer au mieux qu'une douleur est bien d'origine sacroiliaque. Rev Rhum 2009; 76: 741-749
- 13 Slobodin G, Rimar D, Boulman N. et al. Acute sacroiliitis. Clin Rheumatol 2016; 35 (04) 851-856
- 14 Woytala PJ, Sebastian A, Błach K, Silicki J, Wiland P. Septic arthritis of the sacroiliac joint. Reumatologia 2018; 56 (01) 55-58
- 15 Wu MS, Chang SS, Lee SH, Lee CC. Pyogenic sacroiliitis–a comparison between paediatric and adult patients. Rheumatology (Oxford) 2007; 46 (11) 1684-1687
- 16 Kanna RM, Bosco A, Shetty AP, Rajasekaran S. Unilateral sacroiliitis: differentiating infective and inflammatory etiology by magnetic resonance imaging and tissue studies. Eur Spine J 2019; 28 (04) 762-767
- 17 Matt M, Denes E, Weinbreck P. Infectious sacroiliitis: Retrospective analysis of 18 case patients. Med Mal Infect 2018; 48 (06) 383-388
- 18 Kang Y, Hong SH, Kim JY. et al. Unilateral sacroiliitis: Diferential diagnosis between infectious sacroiliitis and spondyloarthritis based on MRI findings. AJR Am J Roentgenol 2015; 205 (05) 1048-1055
- 19 Blum U, Buitrago-Tellez C, Mundinger A. et al. Magnetic resonance imaging (MRI) for detection of active sacroiliitis–a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol 1996; 23 (12) 2107-2115
- 20 Klein MA, Winalski CS, Wax MR, Piwnica-Worms DR. MR imaging of septic sacroiliitis. J Comput Assist Tomogr 1991; 15 (01) 126-132
- 21 Attarian DE. Septic sacroiliitis: the overlooked diagnosis. J South Orthop Assoc 2001; 10 (01) 57-60
- 22 Madsen KB, Egund N, Jurik AG. Grading of inflammatory disease activity in the sacroiliac joints with magnetic resonance imaging: comparison between short-tau inversion recovery and gadolinium contrast-enhanced sequences. J Rheumatol 2010; 37 (02) 393-400
- 23 Özgen A. Comparison of fat-saturated T2-weighted and contrast-enhanced fat-saturated T1-weighted sequences in MR imaging of sacroiliac joints in diagnosing active sacroiliitis. Eur J Radiol 2015; 84 (12) 2593-2596
- 24 Schueller-Weidekamm C, Mascarenhas VV, Sudol-Szopinska I. et al. Imaging and interpretation of axial spondylarthritis: the radiologist's perspective–consensus of the Arthritis Subcommittee of the ESSR. Semin Musculoskelet Radiol 2014; 18 (03) 265-279
- 25 Shemer A, Eshed I, Levinkopf M. Septic Sacroiliitis: A Diagnostic Challenge for the Clinician. Isr Med Assoc J 2018; 20 (01) 58-59
- 26 Vyskocil JJ, McIlroy MA, Brennan TA, Wilson FM. Pyogenic infection of the sacroiliac joint. Case reports and review of the literature. Medicine (Baltimore) 1991; 70 (03) 188-197
- 27 Zimmermann III B, Mikolich DJ, Lally EV. Septic sacroiliitis. Semin Arthritis Rheum 1996; 26 (03) 592-604
- 28 Woytala PJ, Sebastian A, Błach K, Silicki J, Wiland P. Septic arthritis of the sacroiliac joint. Reumatologia 2018; 56 (01) 55-58
- 29 Tuli S. Tuberculosis of the skeletal system. Jaypee Brothers Publication, New Delhi; 2010: 3-15
- 30 Hermet M, Minichiello E, Flipo RM. et al. Infectious sacroiliitis: a retrospective, multicentre study of 39 adults. BMC Infect Dis 2012; 12: 305
- 31 Bernard L, Dinh A, Ghout I. et al; Duration of Treatment for Spondylodiscitis (DTS) study group. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385 (9971): 875-882
- 32 Scott KR, Rising KL, Conlon LW. Infectious sacroiliitis. J Emerg Med 2014; 47 (03) e83-e84
- 33 Cinar M, Sanal HT, Yilmaz S. et al. Radiological followup of the evolution of inflammatory process in sacroiliac joint with magnetic resonance imaging: a case with pyogenic sacroiliitis. Case Rep Rheumatol 2012; 2012: 509136
- 34 Sturzenbecher A, Braun J, Paris S, Biedermann T, Hamm B, Bollow M. RM de la artritis séptica. Skeletal Radiol 2000; 29: 212-215