A report of two cases of brucellar sacroiliitis without systemic manifestations in Greece

Osteoarticular manifestations of human brucellosis: A review

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.

Osteomyelitis variolosa: A probable mediaeval case combined with unilateral sacroiliitis

Osteoarticular sequelae of smallpox (osteomyelitis variolosa) are uncommon today. Such lesions may be observed occasionally, however, in countries where the disease has been endemic. Without other forms of documentation, it is possible to suggest a diagnosis of smallpox in ancient skeletal remains and thus make a significant contribution to understanding the history of this disease. We have examined a subadult male (Skeleton 833), 15-17 years old at the time of death, who presents bilateral bone manifestations of the elbows suggestive of smallpox. No other bone is similarly affected. In addition, he presents a left sacroiliitis deemed to be a brucellar manifestation. Skeleton 833 is one of at least 730 individuals from an exhaustive excavation of a mediaeval necropolis at Pont-sur-Seine (Aube, north-eastern France). Radiocarbon dating of his bones yields a date of between AD 1022 and 1155 (calibrated), thus apparently the oldest case described to date. The other published cases correspond to more recent periods with a well established historical context. We argue that this example of osteomyelitis variolosa.

Pyogenic sacroiliitis in children: two case reports

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.