A case report of pyogenic sacroiliitis in a 9-month-old child

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.

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.

Arthrodesis Using Bilateral Dual Iliac Screws with Autologous Iliac Bone Transfer for the Treatment of Pyogenic Sacroiliitis

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.

Minimally Invasive Sacroiliac Joint Fusion for the Treatment of Brucella Pyogenic Sacroiliitis: A Case Report

A 39-year-old male presented with a two-month history of right hip pain. Computed tomography (CT) scan demonstrated right sacroiliac joint space widening with cortical destruction and erosive changes in the iliopsoas muscle. Minimally invasive right sacroiliac joint fusion was performed with biopsy and aspirate, which confirmed positive Brucella cultures. The patient was started on long-term antibiotic therapy, and his pain significantly improved. Pyogenic sacroiliitis is a rare condition that requires a high index of suspicion. In this case, minimally invasive sacroiliac joint fusion successfully treated the patient’s pain and instability as well as aided in the diagnosis of Brucella infection.

Diagnosis and treatment of low back pain in the pediatric population

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.