Septic arthritis of the sacroiliac joint

Complex Case Management of Mycobacterium Tuberculosis Extrapulmonary Manifestation to the Right Sacroiliac Joint

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 The patient's medical history of developmental delay, psychosis, outdated medication documentation, non-therapeutic use of numerous psychiatric medications contraindicated for traditional anti-tubercular therapy, and socioeconomic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.

Sacroiliac joint beyond sacroiliitis-further insights and old concepts on magnetic resonance imaging

The sacroiliac joint (SIJ) is an amphiarthrosis composed of a posterior syndesmosis and an anterior cartilaginous portion, with limited yet present mobility. Its main function is to transmit the load from the axial skeleton to the lower limbs and vice-versa; it is susceptible to early mechanical and degenerative changes which are much more common than inflammatory sacroiliitis. Magnetic resonance imaging (MRI) has increasingly been used to evaluate these changes, and while subchondral bone marrow edema (BME) is a common finding related to both, care must be taken when applying the ASAS research MRI definition for sacroiliitis without considering lesion BME topography, size and depth, concomitant structural damage and, of course, the clinical picture. In this review, we will discuss the anatomy and biomechanics of the SIJ, the noninflammatory causes of SIJ subchondral BME, and how these concepts combined can be used to increase our diagnostic confidence.

Differentiating nonradiographic axial spondyloarthritis from its mimics: a narrative review

Background

Optimal treatment of nonradiographic axial spondyloarthritis depends on accurate and timely diagnosis of the underlying disease; however, patients present with common symptoms that, in the absence of radiographic changes, may confound diagnosis.

Methods and findings

In this narrative review, a PubMed literature search was conducted through January 2021, with no date limits, to identify English-language publications discussing classification of nonradiographic axial spondyloarthritis, with an emphasis on clinical features and presentation, differential diagnoses, and mimics of disease. This review describes the epidemiology, clinical features, and burden of disease of nonradiographic axial spondyloarthritis as it relates to the overall axial spondyloarthritis spectrum and discusses mimics and differential diagnoses of nonradiographic axial spondyloarthritis that should be considered when evaluating patients with suspected nonradiographic axial spondyloarthritis in clinical practice.

Conclusions

Recognition of clinical features of nonradiographic axial spondyloarthritis, along with an understanding of comorbid conditions such as fibromyalgia, allows for differentiation from its mimics. Appropriate diagnosis of nonradiographic axial spondyloarthritis is important for aggressive management of disease to reduce pain, avoid loss of function, and improve quality of life.

Suspected Septic Sacroiliitis Following Recent Cesarean Section Under Spinal Anesthesia

Septic sacroiliitis is sacroiliac (SI) joint inflammation secondary to microbial invasion of the synovial space characterized by tenderness over the sacroiliac joint, difficulty walking, and lower back pain that can radiate to the buttocks. Clinicians can easily overlook septic sacroiliitis as a potential diagnosis due to its rare occurrence and non-specific symptoms. A 30-year-old female (G2P2A0) who presented acutely to the ED nine days after an uncomplicated Cesarean section performed under spinal anesthesia. The patient experienced progressive lancinating, electric-shock pain originating from the coccyx radiating to the right buttock and lower back with the inability to bear weight. MRI pelvis demonstrated edematous changes of the right SI joint, indicative of septic sacroiliitis. Patient's condition improved after empiric intravenous antibiotics and was discharged home on the continued intravenous course. Rapid empiric administration of intravenous antibiotics may have prevented the onset of severe complications of an infective SI joint.

Management of Instability following Pyogenic Sacroiliitis: Technical Case Report

Background

Septic arthritis of the sacroiliac joint (SI-joint) is a rare and often delayed diagnosis. Management usually consists of intravenous antibiotics and debridement of infected tissue. However, very few reports consider the management of the secondary instability of the sacroiliac joint. Case Presentation. We report a case of a 16-year-old girl diagnosed with S. aureus pyogenic sacroiliitis who benefited from aggressive surgical debridement and primary arthrodesis for infection-related SI-joint instability in the acute infection phase.

Conclusion

Diagnosis of pyogenic sacroiliitis is often delayed. Destruction of the joint can lead to chronic pain and instability. In cases of obvious intraoperative instability, primary arthrodesis could be considered in young patients.

Pyogenic sacroiliitis: A rare complication of inflammatory bowel disease

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.