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Interligator S, Le Bozec A, Cluzel G, Devilder M, Ghaouche J, Guenoun D, Fleury A, Petit Lemaire F, Carlier RY, Valente C, Creze M. Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation. Skeletal Radiol 2024; 53:2247-2262. [PMID: 38110777 DOI: 10.1007/s00256-023-04535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications MATERIALS AND METHODS: This retrospective study included patients with ISI who were evaluated between 2008 and 2021 in a single center. Two radiologists reviewed MRI and CT images to determine the anatomical distribution (unilateral/bilateral, iliac/sacral bone, proximal/middle/distal), severity (bone marrow edema [BME]/periostitis/erosions), concurrent infection (vertebral/nonvertebral), and complications (abscess/probable adjacent osteomyelitis/cavitation/devitalized areas/sequestrum/pelvic venous thrombosis) of ISI. Interobserver reproducibility was assessed. Correlation analysis evaluated the effect of the causative microorganism on severity. Two human bodies were dissected to outline possible ways that ISI can spread. RESULTS Forty patients with ISI (40 years ± 22; 26 women) were evaluated. Ten patients had bilateral ISI. Concurrent vertebral infection was associated in 15% of cases. Reproducibility of sacral BME, periostitis, and reactive locoregional abnormalities was perfect (κ = 1). Reproducibility was low for erosion count (κ = 0.52[0.52-0.82]) and periarticular osteopenia (κ = 0.50[0.18-0.82]). Inflammatory changes were BME (42/42 joints), muscle edema (38/42), and severe periostitis along the ilium (33/37). Destructive structural changes occurred with confluent erosions (iliac, 20/48; sacral, 13/48), sequestrum (20/48), and cavitation (12/48). Complications occurred in 75% of cases, including periarticular abscesses (n = 30/47), probable adjacent osteomyelitis (n = 16/37), and pelvic thrombophlebitis (n = 3). Tuberculous ISI (6/40) correlated with sclerosis (rs = 0.45[0.16; 0.67]; p < 10-2) and bone devitalization (rs = 0.38[0.16; 0.67]; p = .02). The anatomical study highlighted the shared venous vascularization of sacroiliac joints, pelvic organs, and mobile spine. CONCLUSION Complications of ISI are frequent, including abscesses, adjacent osteomyelitis, and periostitis. ISI had bilateral involvement nonrarely and is commonly associated with another spinal infection.
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Affiliation(s)
- Sarah Interligator
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Antoine Le Bozec
- Department of Pharmacy, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Guillaume Cluzel
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Matthieu Devilder
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Jessica Ghaouche
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Daphne Guenoun
- Department of Radiology, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Albane Fleury
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Florian Petit Lemaire
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Robert-Yves Carlier
- Department of Radiology, Hôpital Raymond Poincaré, Assistance-Publique des Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, 92380 Garches, Paris, France
| | - Catarina Valente
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Maud Creze
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France.
- Laboratoire d'Imagerie Biomedicale Multimodale Paris-Saclay, BioMaps, Paris-Saclay University, 4 place du Général Leclerc, 91401 Orsay, Paris, France.
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Çolak AF, Yazar B, Bucağa TM, Demirel K, Aksakal MF, Yalçınkaya B, Çetin A. A rare case presentation of septic sacroiliitis caused by staphylococcus xylosus and complicated with abscess formation: A case report. Diagn Microbiol Infect Dis 2024; 109:116290. [PMID: 38643676 DOI: 10.1016/j.diagmicrobio.2024.116290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024]
Abstract
Septic sacroiliitis is one of the infectious causes of sacroiliitis and it is seen rarely. In current literature, cases of septic sacroiliitis caused by several microorganisms have been reported so far. This case report presents the first case of septic sacroiliitis caused by Staphylococcus xylosus and also complicated with an abscess formation.
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Affiliation(s)
- Ahmet Furkan Çolak
- Department of Physical Medicine and Rehabilitation, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Hacettepe University Medical School, Zemin Kat, FTR AD, Sıhhıye, Ankara 06230, Turkey.
| | - Beytullah Yazar
- Department of Physical Medicine and Rehabilitation, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Hacettepe University Medical School, Zemin Kat, FTR AD, Sıhhıye, Ankara 06230, Turkey
| | - Tuğçe Meryem Bucağa
- Department of Physical Medicine and Rehabilitation, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Hacettepe University Medical School, Zemin Kat, FTR AD, Sıhhıye, Ankara 06230, Turkey
| | - Kübranur Demirel
- Department of Physical Medicine and Rehabilitation, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Hacettepe University Medical School, Zemin Kat, FTR AD, Sıhhıye, Ankara 06230, Turkey
| | - Mahmud Fazıl Aksakal
- Department of Physical Medicine and Rehabilitation, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Hacettepe University Medical School, Zemin Kat, FTR AD, Sıhhıye, Ankara 06230, Turkey
| | - Berkay Yalçınkaya
- Department of Physical Medicine and Rehabilitation, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Hacettepe University Medical School, Zemin Kat, FTR AD, Sıhhıye, Ankara 06230, Turkey
| | - Alp Çetin
- Department of Physical Medicine and Rehabilitation, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Hacettepe University Medical School, Zemin Kat, FTR AD, Sıhhıye, Ankara 06230, Turkey
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3
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Muacevic A, Adler JR, Razzak AN, Jha P, Ugolini C. Complex Case Management of Mycobacterium Tuberculosis Extrapulmonary Manifestation to the Right Sacroiliac Joint. Cureus 2023; 15:e33789. [PMID: 36819328 PMCID: PMC9928219 DOI: 10.7759/cureus.33789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/16/2023] Open
Abstract
While Mycobacterium tuberculosis is a common bacterial pathogen that infects the respiratory system, especially in endemic regions, it may uncommonly manifest in other organ systems, such as the nervous, gastrointestinal, or musculoskeletal systems. Sacroiliac joint infections are rare, and only 1%-5% of all infections are tuberculous in nature. Given nonspecific inflammatory signs in both laboratory and radiologic examinations, early identification of the causative agent can be difficult. In this report, we present the case of a 29-year-old Eritrean woman who presented with an uncommon extrapulmonary tuberculosis manifestation of the right sacroiliac joint. The patient reported pain for two years before a formal diagnosis with multiple computed tomography scans demonstrated fluid collections about her right hip and thigh. The patient's medical history of developmental delay, psychosis, outdated medication documentation, non-therapeutic use of numerous psychiatric medications contraindicated for traditional anti-tubercular therapy, and socioeconomic history of a lack of social support and treatment arrangements with the patient's caregiver all complicated the treatment course. Given the rise in tuberculosis cases worldwide and vulnerability factors in patients with mental illnesses such as poverty, homelessness, diabetes, and HIV infection that can predispose patients to tuberculosis infections, early diagnosis and treatment are essential to reduce long-term consequences and improve clinical outcomes. Further research in the development of new tuberculosis treatment plans is essential to addressing an equitable treatment course alongside fighting against the recent rise in drug-resistant tuberculosis.
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Diogo CC, Trevail R, Moreno‐Aguado B, Quinn R. Long‐term outcome of infectious sacroiliitis due to
Pasteurella multocida
in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Camila Cardoso Diogo
- Department of Veterinary Neurology Southern Counties Veterinary Specialists Ringwood UK
| | - Raquel Trevail
- Department of Veterinary Neurology Southern Counties Veterinary Specialists Ringwood UK
| | - Beatriz Moreno‐Aguado
- Department of Diagnostic Imaging Southern Counties Veterinary Specialists Ringwood UK
| | - Robert Quinn
- Department of Small Animal Surgery Southern Counties Veterinary Specialists Ringwood UK
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Freije T, Patel F, Christenson J, Saysana M. Inability to Bear Weight and Fever in a 16-year-old Boy. Pediatr Rev 2022; 43:593-595. [PMID: 36180541 DOI: 10.1542/pir.2020-003152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Affiliation(s)
- Thomas Freije
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Feenalie Patel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - John Christenson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Michele Saysana
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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Thomas S, Haque S, Radia T. A case report of pyogenic sacroiliitis in a 9-month-old child. Arch Clin Cases 2022; 9:108-111. [PMID: 36176492 PMCID: PMC9512130 DOI: 10.22551/2022.36.0903.10213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A very rare condition, pyogenic sacroiliitis is responsible for 1-2% of all osteoarticular infections in children. Diagnosis is often delayed in the pediatric population due to non-specific signs and symptoms during presentation, difficulty in assessing the joint, more common differential diagnosis and low yield diagnostic findings in conventional radiography. A delayed diagnosis of this condition can lead to permanent joint damage. A 9-month-old presented to the emergency department with a history of fever, being unsettled and clingy along with refusal to weight bear over the past few days. On initial assessment, she was found to be tachycardic and afebrile with abnormal posture of her left leg held in external rotation at the hip joint. On examination, she refused to weight bear, presented with alternating tenderness of her left and right hip joints and spinal tenderness at the L5 position. Investigations done showed slightly raised inflammatory counts, normal hip and pelvic radiographs, normal hip ultrasound and blood culture growing staphylococcus aureus and Magnetic Resonance Imaging spine showing right sacroiliitis leading the diagnosis of pyogenic sacroiliitis. This case report highlights the importance of examination of the back and the importance of avoiding fixation error by history. Although rare, clinicians should consider the diagnosis of sacroiliitis in children who present with fever, being unsettled with decreased and painful movements around the pelvic region.
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Affiliation(s)
- Sarah Thomas
- Corresponding author: Sarah Thomas. King’s College Hospital NHS trust, Denmark Hill, London SE5 9RS, United Kingdom.
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7
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Vereecke E, Herregods N, Morbée L, Laloo F, Chen M, Jans L. Imaging of Structural Abnormalities of the Sacrum: The Old Faithful and Newly Emerging Techniques. Semin Musculoskelet Radiol 2022; 26:469-477. [PMID: 36103888 DOI: 10.1055/s-0042-1754342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The sacrum and sacroiliac joints pose a long-standing challenge for adequate imaging because of their complex anatomical form, oblique orientation, and posterior location in the pelvis, making them subject to superimposition. The sacrum and sacroiliac joints are composed of multiple diverse tissues, further complicating their imaging. Varying imaging techniques are suited to evaluate the sacrum, each with its specific clinical indications, benefits, and drawbacks. New techniques continue to be developed and validated, such as dual-energy computed tomography (CT) and new magnetic resonance imaging (MRI) sequences, for example susceptibility-weighted imaging. Ongoing development of artificial intelligence, such as algorithms allowing reconstruction of MRI-based synthetic CT images, promises even more clinical imaging options.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
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8
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Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is a chronic, rheumatic disease characterized by inflammation of the sacroiliac joint, spine, and entheses. Axial spondyloarthritis affects up to 1.4% of adults in the United States and is associated with decreased quality of life, increased mortality, and substantial health care-related costs, imposing a high burden on patients, their caregivers, and society. SUMMARY OF WORK Diagnosing axSpA can be difficult. In this review, we seek to help rheumatologists in recognizing and diagnosing axSpA. MAJOR CONCLUSIONS A discussion of challenges associated with diagnosis is presented, including use and interpretation of imaging, reasons for diagnostic delays, differences in disease presentation by sex, and differential diagnoses of axSpA. FUTURE RESEARCH DIRECTIONS The early diagnosis of axSpA and advances in available therapeutic options have improved patient care and disease management, but delays in diagnosis and treatment remain common. Additional research and education are critical for recognizing diverse axSpA presentations and optimizing management early in the course of disease.
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Affiliation(s)
- Jessica A. Walsh
- From the University of Utah School of Medicine and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT
| | - Marina Magrey
- The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland, OH
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9
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Acute Sacroiliac Joint Pain: Clinical Presentation, Causes, and Investigations. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-021-00185-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Jeong J, Ko J, Kim J, Eom K, Cho Y, Lee K, Yoon H. Case Report: Multimodality Imaging of Infectious Sacroiliitis and Retroperitoneal Abscess Causing Hindlimb Ataxia in a Young Dog. Front Vet Sci 2021; 8:732788. [PMID: 34722700 PMCID: PMC8554084 DOI: 10.3389/fvets.2021.732788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
A 3-month-old intact male Labrador Retriever was presented for falling trauma and hindlimb ataxia. Radiography indicated radiolucent left sacroiliac joint with irregular margin. Computed tomography revealed thickened sublumbar muscles and hypoattenuated sacroiliac joint while magnetic resonance imaging demonstrated abscess at retroperitoneum and gluteal muscle. Ultrasonography showed lytic left sacroiliac joint with retroperitoneal fluid, and fine needle aspiration resulted Staphylococcus aureus. Hindlimb ataxia was attributed to infectious sacroiliitis and its secondary retroperitoneal abscess. As far as the authors' knowledge, this is the first report of multimodality imaging of infectious sacroiliitis with retroperitoneal abscess caused by S. aureus in a dog.
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Affiliation(s)
- Jeongyun Jeong
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jaeeun Ko
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Kidong Eom
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Youngkwon Cho
- College of Health Sciences, Cheongju University, Cheongju, South Korea
| | - Kichang Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, South Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, South Korea
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11
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Kheder EM, Sharahili HH, Albahrani SY, Alfarhan AM, Alquraynis AM, Maitigue MB, Al Wehaibi AM. Perinatal sacroiliitis diagnostic challenges. SAGE Open Med Case Rep 2021; 9:2050313X211052442. [PMID: 34659772 PMCID: PMC8516381 DOI: 10.1177/2050313x211052442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Lumbo-pelvic pain is a common and non-specific problem during pregnancy and postpartum. Although perinatal pyogenic sacroiliitis is uncommon during this time, it might be difficult to distinguish from reactive sacroiliitis in women who are experiencing significant lower back and pelvic girdle pain, as the symptoms and signs are not clear and the tests are not definitive. A 34-year-old primigravida went to the emergency department with severe lower back pain radiating to the right gluteal region and down to the back of the right thigh. This pain began 12 days prior to her presentation and eventually worsened to the point that she could not stand or walk. Her vital signs were within normal ranges, and she was experiencing a fever. Apart from a slight widening of the symphysis pubis, her pelvic and lumbo-sacral pain X-rays revealed no important findings. With the clinical impression of right lumbo-pelvic pain, the patient was admitted for pain management and further inquiries. Despite the fact that the antibiotherapy was prescribed to treat a urinary tract infection, the significant recovery of the patient's symptoms, even in the absence of a definitive culture of aspirate from the right sacroiliac joint, supported the diagnosis of pyogenic sacroiliitis.
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Affiliation(s)
- Emam M Kheder
- Department of Orthopedics, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Hussain H Sharahili
- Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Salma Y Albahrani
- Department of Internal Medicine, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Abdullah M Alfarhan
- Department of Orthopedics, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | | | - Mahmoud B Maitigue
- Department of Orthopedics, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Ahmed M Al Wehaibi
- Department of Orthopedics, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
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12
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Huang CT, Wang JL, Wu CH. Unprovoked Septic Sacroiliitis Caused by Escherichia coli in a Cirrhotic Patient. J Clin Rheumatol 2021; 27:e234. [PMID: 32195848 DOI: 10.1097/rhu.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chun-Ta Huang
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital and Mackay Medical College, Taipei
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsin Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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13
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Abstract
Pyogenic sacroilitis is an infrequent osteoarticular infection, and its diagnosis is a challenge in young children. A series of 20 cases is described. The median age was 15 months, 75% of them being under 2 years old. Fourteen (70%) reported fever. Refusal to sit was the main reason for consultation. Final diagnosis was confirmed by bone scintigraphy. All patients achieved a complete resolution without sequelae.
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14
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Simon EL, Wainblat EG, Krizo JA, Smalley CM, Fertel BS. Septic Sacroiliitis caused by Serratia marcescens. Am J Emerg Med 2020; 38:2758.e5-2758.e8. [PMID: 32527605 DOI: 10.1016/j.ajem.2020.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Erin L Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA; Northeast Ohio Medical University, Rootstown, Ohio, USA.
| | - Ethan G Wainblat
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA; Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Jessica A Krizo
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA; Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Courtney M Smalley
- Cleveland Clinic Emergency Services Institute, Cleveland Clinic Lerner College of Medicine Cleveland, OH, USA
| | - Baruch S Fertel
- Emergency Services Institute Cleveland Clinic Foundation, Enterprise Quality and Safety, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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Abstract
PURPOSE OF REVIEW Axial spondyloarthritis (AxSpA) is a distinct clinical entity with characteristic clinical and radiographic features; however, a multitude of other metabolic, infectious and inflammatory disorders mimic it both clinically and radiographically. RECENT FINDINGS We present in this review article recent updates about the various disease entities and conditions that may mimic AxSpA and how to differentiate among them. The sensitivity and specificity of MRI in diagnosing AxSpA has limitations and needs to be interpreted in the context of the clinical picture. Interestingly, some recent studies have highlighted that a relatively high prevalence of bone marrow edema on pelvic MRIs in healthy volunteers which could even be categorized as having a 'positive MRI' as defined by Assessment of Spondyloarthritis International Society. Another study revealed that a substantial proportion of patients with suspected sacroiliitis were more commonly diagnosed with diseases other than inflammatory sacroiliitis. On the basis of these reports, it is prudent to request MRIs in the appropriate clinical context and interpreted with caution taking into considerations the wide differential diagnosis of such MRI changes. SUMMARY Highlighting the clinical pearls that differentiate disorders suspected of having sacroiliitis will lead to earlier and correct diagnosis and management; however, one must always take into considerations the radiographic and MRI findings in addition to the clinical presentations in order to make the appropriate diagnosis.
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16
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MRI Findings of Infectious Sacroiliitis in Children: Are There Age-Dependent Differences? AJR Am J Roentgenol 2020; 214:923-929. [PMID: 32045310 DOI: 10.2214/ajr.19.22131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to investigate the prevalence of various MRI findings of infectious sacroiliitis in children and with respect to age. MATERIALS AND METHODS. This institutional review board-approved, HIPAA-compliant retrospective study included children with infectious sacroiliitis who underwent MRI examination between December 1, 2002, and September 30, 2018. Two radiologists blinded to the clinical outcome reviewed each MRI examination to determine the presence or absence of periarticular marrow edema, erosions, capsular bulge, extracapsular edema, and soft-tissue abscess. If available, pelvic radiographs were retrospectively reviewed by a third radiologist. Mann-Whitney U, chi-square, and Fisher exact tests were used to compare MRI findings between younger and older children. RESULTS. The study included 40 children (19 boys and 21 girls; mean age, 8.6 ± 6.2 [SD] years). Sixteen children presented at or below 5 years of age (mean age, 1.7 ± 1.4 years) and 24 children presented at or above 8 years of age (mean age, 13.3 + 2.6 years). Periarticular marrow edema and anterior extracapsular edema were present in all children. Posterior extracapsular edema (p = 0.01) was statistically significantly more common in younger children when compared with older children. There was no significant difference in the presence of erosions (p = 0.60), capsule bulge (p = 0.63), or abscess (p = 0.34) between younger and older children. Pelvic radiographs (n = 28; obtained 1.6 days ± 1.7 from MRI) allowed the correct identification of the abnormal joint in only 50% of the studies. CONCLUSION. MRI findings of infectious sacroiliitis are common in children of all ages with posterior extracapsular edema statistically significantly more prevalent in younger children.
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Kwon JW, Shin JK, Moon SH, Lee HM, Lee BH. Arthrodesis Using Bilateral Dual Iliac Screws with Autologous Iliac Bone Transfer for the Treatment of Pyogenic Sacroiliitis. Yonsei Med J 2020; 61:198-200. [PMID: 31997630 PMCID: PMC6992461 DOI: 10.3349/ymj.2020.61.2.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 11/27/2022] Open
Abstract
Pyogenic sacroiliitis is a relatively rare condition that often leads to surgical treatment, including debridement and arthrodesis. Here we introduce a new surgical technique using bilateral dual iliac screws to secure early ambulation and maximal fusion success rate for the treatment of pyogenic sacroiliitis. We retrospectively reported a case and technical reports of pyogenic sacroiliitis treated by a new bilateral dual iliac screw fixation arthrodesis technique using radiologic outcomes, including plain X-rays and MRI scans, as well as outcomes based on the visual analogue scale for pain measurement. This technique improved uncontrolled pyogenic sacroiliitis with immediate stability that enabled ambulation and secured firm fixation for extensive evacuation of infected debris and subsequent autograft bone arthrodesis. In conclusion, we recommend bilateral dual iliac screw fixation for the treatment of pyogenic sacroiliitis, as this technique can improve uncontrolled pyogenic sacroiliitis with immediate stability.
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Affiliation(s)
- Ji Won Kwon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jong Kwan Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Mo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ho Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
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Pediatric Infectious Sacroiliitis: Characterization and Differentiation from Noninfectious Etiologies. Pediatr Infect Dis J 2019; 38:e134-e137. [PMID: 30985512 DOI: 10.1097/inf.0000000000002340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric sacroiliitis (SI) is an uncommon entity of infectious or inflammatory etiology. Recent data regarding pediatric SI are scarce. The study objective was to describe and compare the clinical features of pediatric infectious and noninfectious SI. METHODS We reviewed files of children ≤18 years of age, admitted with SI in 2004-2017. Patients were grouped by etiology, infectious versus noninfectious. Clinical and laboratory indices, imaging, treatment protocols and outcome were compared. RESULTS Study population included 40 patients with infectious SI (range: 3-192 months, median age: 15 months, 45% female) and 13 patients with noninfectious SI (range: 30-216 months, median age: 168 months, 62% females). Duration of symptoms before admission averaged 5.9 ± 7.5 days in the infectious group and 54.2 ± 96 days in the noninfectious group (P = 0.003). Symptoms observed solely in the infectious group included refusal to stand (n = 27, 77%); walk or crawl (n = 24, 65%); irritability (n = 20, 50%) and recent constipation event (n = 8, 20%). No significant differences in laboratory results were found. Infectious SI patients had uneventful medical history, rapid response to antibiotics and a higher rate of complete resolution of symptoms without recurrences. CONCLUSIONS An acute unilateral presentation in young patients ≤2 years of age, without chronic medical conditions, suggests an infectious etiology of SI anticipated to completely resolve with antibiotic treatment, not necessitating further workup for noninfectious etiologies.
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Arcângelo J, Norte Ramos S, Alves P, Tavares D, Gouveia C. Pyogenic sacroiliitis: Lessons learned from an atypical case series. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Arcângelo J, Norte Ramos S, Alves P, Tavares D, Gouveia C. Sacroileítis piógena: Lecciones aprendidas de una serie de casos atípicos. An Pediatr (Barc) 2019; 91:42-46. [DOI: 10.1016/j.anpedi.2018.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/22/2018] [Accepted: 07/30/2018] [Indexed: 10/26/2022] Open
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Barnes M, Bush C, Jones J. Pyogenic sacroiliitis: A rare complication of inflammatory bowel disease. Am J Emerg Med 2019; 37:1395.e1-1395.e2. [PMID: 31005399 DOI: 10.1016/j.ajem.2019.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/06/2023] Open
Abstract
Although sacroiliitis is not uncommon in patients with inflammatory bowel diseases (IBD), bacterial infection of the sacroiliac joint is rare. The diagnosis is often delayed because of low clinical suspicion, a vague clinical picture and poorly defined localization of symptoms. We report a case of pyogenic sacroiliitis in a patient with Crohn's disease caused by Clostridia spp. and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness.
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Affiliation(s)
- Mariah Barnes
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States of America
| | - Colleen Bush
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States of America
| | - Jeffrey Jones
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States of America.
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22
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Pyogenic sacroiliitis in children: don't forget the very young. Eur J Pediatr 2019; 178:575-579. [PMID: 30734096 DOI: 10.1007/s00431-019-03333-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
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 ≤ 16 years 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 1.1 years) 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 11.6 years) 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.
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Chee YC, Lim CH. Klebsiella pneumoniae sacroiliac septic arthritis: First case report. IDCases 2018; 14:e00459. [PMID: 30386726 PMCID: PMC6205928 DOI: 10.1016/j.idcr.2018.e00459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 09/30/2018] [Accepted: 10/14/2018] [Indexed: 11/23/2022] Open
Abstract
Infective sacroiliitis is a rare disease with misleading clinical signs that often delay diagnosis. We report a case of pyogenic sacroiliac joint septic arthritis caused by Klebsiella pneumoniae that has not been reported in the literature highlighting its importance especially among diabetics.
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Affiliation(s)
- Yong Chuan Chee
- Department of Internal Medicine, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
- Corresponding author at: Hospital Sultanah Bahiyah, KM 6, Jalan Langgar, Alor Setar, Kedah, Malaysia.
| | - Chong Hong Lim
- Rheumatology Unit, Department of Internal Medicine, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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Septic Sacroiliitis in a 53-Year-Old Adult: A Case Report. PM R 2018; 11:210-213. [PMID: 29860020 DOI: 10.1016/j.pmrj.2018.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/19/2018] [Indexed: 10/14/2022]
Abstract
A 53-year-old woman with no significant medical history presented with 10/10 right buttock pain that radiated to the right groin. With no reported recent injury, the absence of fever, and no identifiable risk factors, an infectious etiology, including septic sacroiliitis (SSI), is at the end spectrum of the differential. SSI is a rare condition with nonspecific findings that can lead to major complications, including death. To our knowledge, there are only 4 recent major literature reviews on SSI, with most cases reported to have at least 1 risk factor or clinical sign indicating the possibility of an infectious etiology. The patient reported in this case had no identifiable risk factors; therefore, high clinical suspicion is needed to prevent debilitating consequences from prolonged infection. LEVEL OF EVIDENCE: V.
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25
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Knipp D, Simeone FJ, Nelson SB, Huang AJ, Chang CY. Percutaneous CT-guided sacroiliac joint sampling for infection: aspiration, biopsy, and technique. Skeletal Radiol 2018; 47:473-482. [PMID: 29143113 DOI: 10.1007/s00256-017-2809-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate methods of CT-guided sacroiliac joint sampling in patients with suspected infection. MATERIALS AND METHODS All CT-guided sacroiliac joint sampling procedures for suspected infection were reviewed for sampling type (aspiration, lavage aspiration, biopsy), microbiology results, and clinical and imaging follow-up. The primary gold standard was anatomic pathology. If pathology was not available, then positive blood culture with the same organism as SIJ sampling, imaging and clinical follow-up, or clinical follow-up only were used. Anterior and posterior joint distention was evaluated by MRI within 7 days of the procedure. RESULTS A total of 34 patients (age 39 ± 20 (range, 6-75) years; 21 F, 13 M) were included. Aspiration samples only were obtained in 13/34 (38%) cases, biopsy samples only in 9/34 (26%) cases, and both samples in 12/34 (35%) cases. There was an overall 54% sensitivity and 86% specificity. For the aspiration samples, sensitivity and specificity were 60 and 81%, respectively, compared to 45 and 90% for the biopsy samples. In cases with both samples, biopsy did not add additional microbial information. Seventeen (17/34, 50%) patients had an MRI. The anterior joint was more distended than the posterior joint in 15/17 (88%) of patients, and this difference was significant (P = 0.0003). All of these 17 patients had an attempted aspiration by a posterior approach; 6/17 (35%) resulted in a successful aspiration. CONCLUSIONS Aspiration of the sacroiliac joint has a higher sensitivity than biopsy and should always be attempted first. MRI may be helpful for procedure planning.
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Affiliation(s)
- David Knipp
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Sandra B Nelson
- Infectious Disease Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ambrose J Huang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
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Abstract
Septic arthritis is an inflammation of a joint caused directly by various microorganisms. It is often characterized by many unspecific symptoms. Bacteria is the most often etiological factor. We present a case report of a 76-years old woman with a unilateral septic arthritis of the sacroiliac joint. Bacterial sacroiliitis should be taken into account in patients with sacroiliitis and fever onset. Proper diagnosis can be very often difficult and delayed but fast implementation of antibiotic therapy is extremely important in the treatment process. Diagnostic imaging is crucial to the diagnosis and monitoring of septic arthritis. Magnetic resonance imaging is the most relevant tool for the detection of sacroiliitis, allowing the institution of therapeutic strategies to impede the progression of the disease.
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Pediatric Sacroiliitis: Clinical and Microbiologic Differences Between Infants and Children-Adolescents. Pediatr Infect Dis J 2017; 36:631-634. [PMID: 28002357 DOI: 10.1097/inf.0000000000001502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to improve knowledge of pediatric pyogenic sacroiliitis (PSI) in the pediatric population based on a consecutive case series. METHOD 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. RESULTS 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. CONCLUSION 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.
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Patel R, Monem M, Sherief T. Unilateral infective sacroiliitis in a boy presenting with a limp. BMJ Case Rep 2017; 2017:bcr-2017-219279. [PMID: 28478389 DOI: 10.1136/bcr-2017-219279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 9-year-old boy admitted to a district general hospital with a 1-week history of fever and a 2-day history of right hip pain. Initial workup revealed raised inflammatory markers and unremarkable imaging studies. After clinical review, there was minimal improvement of the patient's condition 5 days after presentation; therefore, an MRI of the pelvis/hips was carried out, which supported a clinical diagnosis of right-sided infective sacroiliitis. Infective sacroiliitis is rare and only represents 1%-2% of septic arthritis in children. The condition still remains a diagnostic challenge first due to poor localisation of symptoms with referred pain to the hip, thigh and lower back and second due to a lack of awareness by non-specialist clinicians. Early diagnosis is a key to avoid sequelae such as an abscess, degenerative changes of the sacroiliac joint and can be achieved by a thorough clinical examination, monitoring inflammatory markers and MRI.
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Affiliation(s)
| | - Mohammed Monem
- Otolaryngology, East and North Hertfordshire NHS Trust, Stevenage, UK
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29
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Antonelli MJ, Magrey M. Sacroiliitis mimics: a case report and review of the literature. BMC Musculoskelet Disord 2017; 18:170. [PMID: 28431581 PMCID: PMC5401462 DOI: 10.1186/s12891-017-1525-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/07/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiographic sacroiliitis is the hallmark of ankylosing spondylitis (AS), and detection of acute sacroiliitis is pivotal for early diagnosis of AS. Although radiographic sacroiliitis is a distinguishing feature of AS, sacroiliitis can be seen in a variety of other disease entities. CASE PRESENTATION We present an interesting case of sacroiliitis in a patient with Paget disease; the patient presented with inflammatory back pain which was treated with bisphosphonate. This case demonstrates comorbidity with Paget disease and possible ankylosing spondylitis. We also present a review of the literature for other cases of Paget involvement of the sacroiliac joint. CONCLUSIONS In addition, we review radiographic changes to the sacroiliac joint in classical ankylosing spondylitis as well as other common diseases. We compare and contrast features of other diseases that mimic sacroiliitis on a pelvic radiograph including Paget disease, osteitis condensans ilii, diffuse idiopathic skeletal hyperostosis, infections and sarcoid sacroiliitis. There are some features in the pelvic radiographic findings which help distinguish among mimics, however, one must also rely heavily on extra-pelvic radiographic lesions. In addition to the clinical presentation, various nuances may incline a clinician to the correct diagnosis; rheumatologists should be familiar with the imaging differences among these diseases and classic spondylitis findings.
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Affiliation(s)
- Maria J Antonelli
- Case Western Reserve University, MetroHealth Medical Center, Divison of Rheumatology, 2500 MetroHealth Dr., Cleveland, OH, 44109, USA.
| | - Marina Magrey
- Case Western Reserve University, MetroHealth Medical Center, Divison of Rheumatology, 2500 MetroHealth Dr., Cleveland, OH, 44109, USA
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Rashed R, Younis F. Methicillin Resistant Staphylococcus Aureus Sacroiliac Joint Septic Arthritis in an Adult Patient Treated with Daptomycin. J Bone Jt Infect 2017; 2:143-148. [PMID: 28540151 PMCID: PMC5441146 DOI: 10.7150/jbji.18358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sacroiliac joint septic arthritis is a rare disease entity representing 1-2% of all cases of septic arthritis. Establishment of the diagnosis is often challenging given the non-specific presenting features and the potential cross-over with other pathologies. We report the case of a 50 year old gentleman who suffers with psoriasis and presented with sacroiliac joint septic arthritis complicated by Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia and an iliopsoas abscess. This was successfully treated conservatively with a course of the novel antibiotic Daptomycin.
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31
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Acute sacroiliitis. Clin Rheumatol 2016; 35:851-6. [DOI: 10.1007/s10067-016-3200-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/09/2016] [Accepted: 01/28/2016] [Indexed: 11/25/2022]
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Leroux J, Bernardini I, Grynberg L, Grandguillaume C, Michelin P, Ould Slimane M, Nectoux E, Deroussen F, Gouron R, Angelliaume A, Ilharreborde B, Renaux-Petel M. Pyogenic Sacroiliitis in a 13-Month-Old Child: A Case Report and Literature Review. Medicine (Baltimore) 2015; 94:e1581. [PMID: 26496260 PMCID: PMC4620820 DOI: 10.1097/md.0000000000001581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pyogenic sacroiliitis is exceptional in very young children. Diagnosis is difficult because clinical examination is misleading. FABER test is rarely helpful in very young children. Inflammatory syndrome is frequent. Bone scintigraphy and MRI are very sensitive for the diagnosis. Joint fluid aspiration and blood cultures are useful to identify the pathogen. Appropriate antibiotic therapy provides rapid regression of symptoms and healing. We report the case of pyogenic sacroiliitis in a 13-month-old child.Clinical, biological, and imaging data of this case were reviewed and reported retrospectively.A 13-month-old girl consulted for decreased weight bearing without fever or trauma. Clinical examination was not helpful. There was an inflammatory syndrome. Bone scintigraphy found a sacroiliitis, confirmed on MRI. Aspiration of the sacroiliac joint was performed. Empiric intravenous biantibiotic therapy was started. Patient rapidly recovered full weight bearing. On the 5th day, clinical examination and biological analysis returned to normal. Intravenous antibiotic therapy was switched for oral. One month later, clinical examination and biological analysis were normal and antibiotic therapy was stopped.Hematogenous osteoarticular infections are common in children but pyogenic sacroiliitis is rare and mainly affects older children. Diagnosis can be difficult because clinical examination is poor. Moreover, limping and decreased weight bearing are very common reasons for consultation. This may delay the diagnosis or refer misdiagnosis. Bone scintigraphy is useful to locate a bone or joint disease responsible for limping. In this observation, bone scintigraphy located the infection at the sacroiliac joint. Given the young age, MRI was performed to confirm the diagnosis. Despite the very young age of the patient, symptoms rapidly disappeared with appropriate antibiotic therapy.We report the case of pyogenic sacroiliitis in a 13-month-old child. It reminds the risk of misdiagnosing pyogenic sacroiliitis in children because it is exceptional and clinical examination is rarely helpful. It also highlights the usefulness of bone scintigraphy and MRI in osteoarticular infections in children.
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Affiliation(s)
- Julien Leroux
- From the Clinique Chirurgicale Infantile, CHU de Rouen, Hôpital Charles Nicolle, Rouen cedex (JL, IB, LG, MR-P); Université de Rouen, Mont-Saint-Aignan (JL, IB, LG, CG, MR-P, MOS); Département d'Anesthésie et Réanimation, CHU de Rouen, Hôpital Charles Nicolle (CG); Service de Radiologie, CHU de Rouen, Hôpital Charles Nicolle (PM); Service de Chirurgie Orthopédique et Traumatologique, CHU de Rouen, Hôpital Charles Nicolle, Rouen cedex (MOS); Service de Chirurgie et d'Orthopédie de l'Enfant, CHRU de Lille, Lille cedex (EN); Université Lille 2 Droit et Santé, Lille (EN); Service de Chirurgie de l'Enfant, CHU Amiens-Picardie site sud, Amiens cedex 1 (FD, RG); Université de Picardie, Amiens (FD, RG); Service de Chirurgie Infantile, CHU de Bordeaux, Hôpital des Enfants, place Amélie Raba-Léon Bordeaux (AA); Université de Bordeaux, Collège Sciences de la Santé, Bordeaux cedex (AA); Service d'Orthopédie Pédiatrique, Assistance Publique des Hôpitaux de Paris, Hôpital Robert Debré, Paris (BI); and Université Paris Diderot Paris 7, Paris, France (BI)
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Kim JS, Ko JH, Lee S, Jeon SC, Oh SH. Enterobacter cloacae Sacroiliitis with Acute Respiratory Distress Syndrome in an Adolescent. Infect Chemother 2015; 47:125-8. [PMID: 26157593 PMCID: PMC4495273 DOI: 10.3947/ic.2015.47.2.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 07/04/2014] [Accepted: 08/03/2014] [Indexed: 12/21/2022] Open
Abstract
Enterobacter cloacae has emerged as an important nosocomial pathogen, but is rarely a cause of sacroiliitis. Herein, we present the first reported case of Enterobacter cloacae sacroiliitis associated with sepsis and acute respiratory distress syndrome (ARDS). A previously healthy 14-year-old boy presented with low-grade fever and pain in the left side of the hip that was aggravated by walking. Pelvic computed tomography (CT) showed normal findings, and the patient received supportive care for transient synovitis with no antibiotics. However, there was no clinical improvement. On the third day of hospitalization, magnetic resonance imaging of the hip revealed findings compatible with sacroiliitis, for which vancomycin and ceftriaxone were administered. The patient suddenly developed high fever with dyspnea. Chest radiography and CT findings and a PaO2/FiO2 ratio <200 mmHg were suggestive of ARDS; the patient subsequently received ventilatory support and low-dose methylprednisolone infusions. Within one week, defervescence occurred, and the patient was able to breathe on his own. Following the timely recognition of, and therapeutic challenge to, ARDS, and after 6 weeks of parenteral antimicrobial therapy, the patient was discharged in good health with no complications.
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Affiliation(s)
- Jin Soo Kim
- Department of Pediatrics and Adolescent, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hee Ko
- Department of Pediatrics and Adolescent, Hanyang University College of Medicine, Seoul, Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Seok Chol Jeon
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Hee Oh
- Department of Pediatrics and Adolescent, Hanyang University College of Medicine, Seoul, Korea
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Kucera T, Brtkova J, Sponer P, Ryskova L, Popper E, Frank M, Kucerova M. Pyogenic sacroiliitis: diagnosis, management and clinical outcome. Skeletal Radiol 2015; 44:63-71. [PMID: 25231169 DOI: 10.1007/s00256-014-1999-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 08/18/2014] [Accepted: 08/28/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Tomas Kucera
- Department of Orthopaedic Surgery, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Sokolska 581, 500 05, Hradec Kralove, Czech Republic,
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35
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Denouement. Pediatr Infect Dis J 2014; 33:672-3. [PMID: 24830522 DOI: 10.1097/inf.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abid H, Chaabouni S, Frikha F, Toumi N, Souissi B, Lahiani D, Bahloul Z, Ben Mahfoudh K. [Contribution of imaging in the diagnosis of infectious sacroiliitis: about 19 cases]. Pan Afr Med J 2014; 17:171. [PMID: 25120884 PMCID: PMC4119445 DOI: 10.11604/pamj.2014.17.171.2716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 10/10/2013] [Indexed: 12/05/2022] Open
Abstract
Les sacro-iliites infectieuses méritent d’être mieux connues. Leur diagnostic est souvent retardé en raison d'une symptomatologie trompeuse et des diffcultés d'exploration de l'articulation sacro-iliaque. Notre travail est basé sur une étude rétrospective portant sur les cas de SII, recueillis sur une période comprise entre 1997 et 2008 dans notre centre universitaire Sfax-Tunisie. Le diagnostic de sacro-iliite était retenu en présence d'arguments cliniques et radiologiques d'atteinte sacroiliaque. Nous rapportons dix neuf cas de sacroiliites infectieuses (10 hommes et 9 femmes), avec un âge moyen de 32 ans. L'atteinte était unilatérale dans tous les cas. Les radiographies standard faites dans tous les cas ont été suggestives dans 14 cas et normales dans les autres cas. La TDM faite dans 13 cas a montré, un abcès des parties molles dans 8 cas et un séquestre osseux dans 2 cas. L'IRM réalisée dans 8 cas, a objectivé une infiltration des parties molles dans tous les cas et un abcès dans 3 cas. Le germe a été identifié dans 9 cas (3 cas de tuberculose, 3 cas de brucellose, 2 sacro-iliites à pyogène et un cas de candidose). Cette identification était faite par biopsie dans 3 cas, hémocultures dans 2 cas, prélèvement au niveau de la porte d'entrée dans 1 cas et sérodiagnostic dans 3 cas. Pour les autres cas, l'origine pyogène a été retenue sur des arguments cliniques et biologiques. L'imagerie joue un rôle primordial dans le diagnostic précoce et l'orientation étiologique d'une sacroiliite infectieuse.
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Affiliation(s)
- Hanen Abid
- Service de Radiologie CHU Habib Bourguiba 3029 Sfax, Tunisie
| | - Salim Chaabouni
- Service de Radiologie CHU Habib Bourguiba 3029 Sfax, Tunisie
| | - Faten Frikha
- Service de Médecine interne CHU Hédi Chaker 3029 Sfax, Tunisie
| | - Nozha Toumi
- Service de Radiologie CHU Habib Bourguiba 3029 Sfax, Tunisie
| | - Basma Souissi
- Service de Radiologie CHU Habib Bourguiba 3029 Sfax, Tunisie
| | - Dorra Lahiani
- Service de maladies infectieuses CHU Hédi Chaker 3029 Sfax, Tunisie
| | - Zouhir Bahloul
- Service de Médecine interne CHU Hédi Chaker 3029 Sfax, Tunisie
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Abstract
Back pain in the pediatric population is a common complaint presenting to sports medicine clinics. There is a wide differential that should be considered, including mechanical, infectious, neoplastic, inflammatory, and amplified musculoskeletal pain. The history, pain quality, and examination are key components to help distinguish the etiologies of the pain and direct further evaluation. Laboratory investigations, including blood counts and inflammatory markers, can provide insight into the diagnosis. The HLA-B27 antigen can be helpful if a spondyloarthropathy is suspected. Imaging as clinically indicated typically begins with radiographs, and the use of MRI, CT, or bone scan can provide additional information. Proper diagnosis of back pain is important because prognosis and treatments are significantly different. We review the pertinent evaluation, differential diagnoses, and treatment of low back pain in the pediatric population.
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Affiliation(s)
- Alysha J. Taxter
- Division of Rheumatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy A. Chauvin
- Division of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pamela F. Weiss
- Division of Rheumatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Kim S, Lee KL, Baek HL, Jang SJ, Moon SM, Cho YK. A Case of Acute Pyogenic Sacroiliitis and Bacteremia Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus. Infect Chemother 2014; 45:441-5. [PMID: 24475359 PMCID: PMC3902811 DOI: 10.3947/ic.2013.45.4.441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/25/2013] [Accepted: 07/25/2013] [Indexed: 11/24/2022] Open
Abstract
Pyogenic sacroiliitis is a rare osteoarticular infection, occurring most frequently in children and young adults. Diagnosis of the disease is challenging because of a general lack of awareness of the disease and its nonspecific signs and symptoms. Staphylococcus aureus is the most common causative bacteria in pyogenic sacroiliitis. Methicillin-resistant S. aureus (MRSA) has typically been considered a hospital-associated pathogen; however, community-acquired (CA)-MRSA infections are becoming increasingly common in Korea. We report the first domestic case of acute pyogenic sacroiliitis with abscess and bacteremia caused by CA-MRSA. The pathogen carried the type IV-A staphylococcal cassette chromosome mec (SCCmec) without the Panton-Valentine leukocidin (PVL) gene, and was identified as sequence type (ST) 72 by multilocus sequence typing.
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Affiliation(s)
- Suyoung Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kang Lock Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hae Lim Baek
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Jun Jang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Song Mi Moon
- Division of Infectious Disease, Gachon University Gil Medical Center, Incheon, Korea
| | - Yong Kyun Cho
- Division of Infectious Disease, Gachon University Gil Medical Center, Incheon, Korea
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39
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MRI of the SI joints commonly shows non-inflammatory disease in patients clinically suspected of sacroiliitis. Eur J Radiol 2014; 83:179-84. [DOI: 10.1016/j.ejrad.2013.10.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/19/2013] [Accepted: 10/04/2013] [Indexed: 01/25/2023]
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40
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Bozkurt MF, Kiratli P. Quantitative sacroiliac scintigraphy for pediatric patients: comparison of two methods. Ann Nucl Med 2013; 28:227-31. [PMID: 24368698 DOI: 10.1007/s12149-013-0799-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 12/14/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Quantitative bone scintigraphy is a useful method to diagnose sacroiliitis. However, there is significant overlap between healthy and pathological sacroiliac index (SI) values for adult patients, while there are no such sufficient data for children. This study was aimed mainly to assess normal SI values in different age groups of pediatric patients using 2 different quantitative methods. MATERIALS AND METHODS Normally reported bone scans of 79 children were retrospectively reviewed. Two different methods were used for quantitation. For the first method, sacrum was used as a background site while L5 vertebra was used instead for the second method. Right/left SI values of both methods were compared with each other in relation with gender and different age groups, as group 1 (1-5 years), group 2 (6-10 years), group 3 (11-15 years) and group 4 (16-18 years). Additional comparison was made with a group of young-adult population of 21-30 years old as group 5 to assess the effect of age. RESULTS Gender-based comparison yielded significantly higher SI for females for the first method, while no significant difference existed for the second one. Significant increase in SI with both methods was found as age increased. Significantly lower SI was found from the second method, when similar age groups like group 1-2 or group 2-3 were compared with each other, while no such difference existed for the first method. For each individual patient from any age group, method-based comparison resulted in a significantly different SI with both methods. CONCLUSIONS In pediatric population, SI tends to increase as age increases. Quantitation method using sacrum as background yields significantly higher SI for female gender. Alternative use of L5 as background site for quantitation performs well in children. Since two methods resulted in significantly different SI, individualized cut-off values for each age group for any method are practically warranted.
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Affiliation(s)
- Murat Fani Bozkurt
- Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey,
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41
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Bolt RJ, Øistad LG, Dragoiescu C, Hartwig NG. Fever, diarrhoea and buttock pain in a 15-year-old female traveller (discussion and diagnosis). Acta Paediatr 2013; 102:1204-5. [PMID: 25132432 DOI: 10.1111/apa.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 08/08/2013] [Accepted: 08/09/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Roel J Bolt
- Department of Paediatrics, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
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Travel-Associated Salmonella mbandaka Sacroiliac Osteomyelitis in a Healthy Adolescent. Case Rep Infect Dis 2013; 2013:543147. [PMID: 23607008 PMCID: PMC3623109 DOI: 10.1155/2013/543147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/04/2013] [Indexed: 11/25/2022] Open
Abstract
Pyogenic infections of the sacroiliac joint are rare and usually caused by Staphylococcus aureus. We describe a case of a 16 year-old gymnast who was subsequently diagnosed with Salmonella mbandaka sacroiliac osteomyelitis with adjacent psoas abscess and hepatitis one week after returning from a holiday in Crete. This case highlights a rare presentation of a common travel-associated foodborne infection.
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43
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Hermet M, Minichiello E, Flipo RM, Dubost JJ, Allanore Y, Ziza JM, Gaudin P, Thomas T, Dernis E, Glace B, Regnier A, Soubrier M. Infectious sacroiliitis: a retrospective, multicentre study of 39 adults. BMC Infect Dis 2012; 12:305. [PMID: 23153120 PMCID: PMC3519695 DOI: 10.1186/1471-2334-12-305] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 11/08/2012] [Indexed: 11/23/2022] Open
Abstract
Background Non-brucellar and non-tuberculous infectious sacroiliitis (ISI) is a rare disease, with misleading clinical signs that delay diagnosis. Most observations are based on isolated case reports or small case series. Our aim was to describe the clinical, bacteriological, and radiological characteristics of ISI, as well as the evolution of these arthritis cases under treatment. Methods This retrospective study included all ISI cases diagnosed between 1995 and 2011 in eight French rheumatology departments. ISI was diagnosed if sacroiliitis was confirmed bacteriologically or, in the absence of pathogenic agents, if clinical, biological, and radiological data was compatible with this diagnosis and evolution was favourable under antibiotic therapy. Results Overall, 39 cases of ISI were identified in adults, comprising 23 women and 16 men, with a mean age at diagnosis of 39.7 ± 18.1 years. The left sacroiliac joint (SI) was affected in 59% of cases, with five cases occurring during the post-partum period. Lumbogluteal pain was the most common symptom (36/39). Manipulations of the SI joint were performed in seven patients and were always painful. Mean score for pain using the visual analogue score was 7.3/10 at admission, while 16 patients were febrile at diagnosis. No risk factor was found for 30.7% of patients. A diagnosis of ISI was only suspected in five cases at admission. The mean time to diagnosis was long, being 43.3 ± 69.1 days on average. Mean C-reactive protein was 149.7 ± 115.3 mg/l, and leukocytosis (leukocytes ≥ 10 G/l) was uncommon (n = 15) (mean level of leukocytes 10.4 ± 3.5 G/l). Radiographs (n = 33) were abnormal in 20 cases, revealing lesions of SI, while an abdominopelvic computed tomography (CT) scan (n = 27) was abnormal in 21 cases, suggesting arthritis of the SI joints in 13 cases (48.1%) and a psoas abscess in eight. Bone scans (n = 14) showed hyperfixation of the SI in 13 cases. Magnetic resonance imaging (MRI) (n = 27), when focused on the SI (n = 25), directed towards the diagnosis to ISI in 25 cases. Pathogenic agents were isolated in 33 cases (84.6%) by means of articular puncture (n = 16), blood culture (n = 14), cytobacteriological examination of urine (n = 2), or puncture of the psoas (n = 1). Gram-positive cocci were the mostly isolated common bacteria, with a predominance of staphylococci (n = 21). The most frequently isolated gram-negative bacillus was Pseudomonas aeruginosa (n = 3). Evolution was favourable in 37 out of 39 patients under prolonged antibiotic therapy (mean duration 3.01 ± 1.21 months). Conclusion Our series confirmed that the clinical manifestations of ISI usually lead to delayed diagnosis. Based on our results, we suggest performing an MRI of the spine and SI in clinical situations characterised by lumbogluteal pain and symptoms of an infectious disease, such as fever.
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Affiliation(s)
- Marion Hermet
- Service de Médecine Interne, Hôpital G, Montpied, CHU de Clermont-Ferrand, 58 rue Montalembert, Cedex 1, Clermont-Ferrand 63003, France.
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44
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Abstract
In athletes, acute bacterial infection is an unusual cause of pain in the sacroiliac joint. Although an entry site for infection is not always evident, the present case of a 15-year-old rugby player suggests the association between right sacroiliac joint infection and skin lesion of atopic dermatitis (AD) infected with group A streptococcus. Magnetic resonance imaging revealed inflammation around the sacroiliac joint with abscess formation. The infection resolved after a course of antibiotics. Because atopic skin lesion is a potential portal of bacteria, treatment for AD is essential for the prevention of pyogenic arthritis in athletes.
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45
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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. [PMID: 23050188 PMCID: PMC3461616 DOI: 10.1155/2012/509136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 08/29/2012] [Indexed: 11/25/2022] Open
Abstract
Pyogenic sacroiliitis (PS) is an acute form of sacroiliitis that mostly starts with very painful buttock pain. Here in this case, the followup magnetic resonance (MR) images of a 49-year-old male patient with PS is displayed. After his sacroiliitis was documented by MR images, he was treated with the combination of rifampicin plus streptomycin and moxifloxacin. Serial MR investigations were done to disclose acute and subsequent imaging changes concerning sacroiliac joint and surrounding bone structures. Although after treatment all the symptoms were completely resolved, 20 months later changes suggesting active sacroiliitis on MR images were continuing.
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46
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Pyogenic sacroiliitis in children: two case reports. Case Rep Med 2012; 2012:415323. [PMID: 22829838 PMCID: PMC3398623 DOI: 10.1155/2012/415323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 04/12/2012] [Accepted: 06/08/2012] [Indexed: 11/18/2022] Open
Abstract
Pyogenic sacroiliitis is rare and accounts for approximately 1-2% of osteoarticular infections in children. Considerable delay between presentation and diagnosis is recognized. Two cases of pyogenic sacroiliitis are described. The first case is a 28-month-old girl presented with acute onset of fever, pain in the left hip, and limpness. Computed tomography (CT), bone scans, and magnetic resonance imaging (MRI) of the pelvis showed characteristic findings of infectious sacroiliitis, and blood cultures were negatives. The second case is a 13-year-old girl presented with acute onset of fever, pain in the right hip, and buttock, with inability to walk. The diagnosis of pyogenic sacroiliitis was confirmed by bone scans, and CT of the pelvis and blood cultures have identified Proteus mirabilis. The two children recovered fully after 6 weeks of antimicrobial therapy. Pyogenic sacroiliitis is an uncommon disease in children. The key to successful management is early diagnosis in which CT, bone scans, and MRI findings play a crucial role. If the diagnosis is established promptly, most patients can be managed successfully with antimicrobial therapy.
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47
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Gupta SS, Gurjar D, Gupta A, Prasad N, Sharma RK, Saxena A, Kaul A, Bhadauria DS. Pyogenic sacroiliitis in a renal allograft recipient. INDIAN JOURNAL OF TRANSPLANTATION 2012. [DOI: 10.1016/s2212-0017(12)60112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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48
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Lam SK, Wong OF, Lau CL, Fung HT. CT Quiz: A 51-Year-Old Female Presenting with Right Lower Quadrant Pain. HONG KONG J EMERG ME 2011. [DOI: 10.1177/102490791101800311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - OF Wong
- Tuen Mun Hospital, Department of Anaesthesia & Intensive Care, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
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49
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Mora-de Sambricio A, Marimón-Juan I, Rius-Dalmau M, Pérez-López A. Sacroileítis piógena en el niño y el adulto joven. A propósito de tres casos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2010.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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50
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Mora-De Sambricio A, Marimón-Juan I, Rius-Dalmau M, Pérez-López A. Pyogenic sacroiliitis in the child and young adult. Three case reports. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/s1988-8856(11)70294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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