Osteomyelitis and pyogenic sacroiliitis: A difficult diagnosis

Ford, L T; Ellis, Andrew; Allen, H.E.; Campbell, Dianne E.

doi:10.1111/j.1440-1754.2004.00372.x

Cited by 28 publications

(24 citation statements)

References 8 publications

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“…Ultrasound has not been helpful except to exclude hip-joint effusions [16]. Isotope bone scanning is an essential tool for early diagnosis with an excellent sensitivity [3].…”

Section: Discussionmentioning

confidence: 99%

Pyogenic Sacroiliitis in Children: Two Case Reports

Besbès

Haddad

Abid

et al. 2012

Case Reports in Medicine

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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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“…Ultrasound has not been helpful except to exclude hip-joint effusions [16]. Isotope bone scanning is an essential tool for early diagnosis with an excellent sensitivity [3].…”

Section: Discussionmentioning

confidence: 99%

Pyogenic Sacroiliitis in Children: Two Case Reports

Besbès

Haddad

Abid

et al. 2012

Case Reports in Medicine

View full text Add to dashboard Cite

show abstract

“…The initial antimicrobial approach is similar to the standard regimens empirically recommended in other bone and joint infections in children, and must include antibiotics with potent bactericidal activity against Gram-positive cocci, especially Staphylococcus aureus, which is the main microorganism involved in the aetiology of this entity (1,5,6). In addition, because of the lack of specific guidelines, it is difficult to establish the optimal duration of the therapy and the timing for switching from parenteral to oral antimicrobials.…”

Section: Discussionmentioning

confidence: 98%

“…The typical symptoms of fever, buttock pain, and limping gait are often absent. Furthermore, because of the complex anatomy of the sacroiliac joint, the pain is commonly found to be referred to other sites such as the lower back, abdomen, thigh, or hip, and can mimic a number of processes other than sacroiliitis, leading to a considerable diagnostic delay in many cases (1,5,6). Several physical examination manoeuvres aimed at eliciting specific signs of sacroiliac joint inflammation, such as Gaenslen's and Fabere tests, direct compression over the sacroiliac joint, and pelvic compression, are cited in almost all series of pyogenic sacroillitis.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical drainage is only indicated in the case of an important abscess or sequestrum (1). Although open joint debridement is the classical surgical approach, less invasive procedures such as percutaneous aspiration of an iliopsoas abscess under CT guidance or drainage of the infected joint using a percutaneous sacroiliac screw insertion have been described recently (6,13).…”

Section: Discussionmentioning

confidence: 99%

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Pneumococcal sacroiliitis in a 4‐year‐old boy

Pérez¹,

Padilla²,

Marco³

et al. 2008

Scandinavian Journal of Rheumatology

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Pyogenic sacroiliitis is an extremely rare manifestation of invasive pneumococcal disease in childhood as only four cases have been described to date. We report and comment on a case of pneumococcal sacroiliitis in a 4-year-old boy. This patient was diagnosed promptly on account of the symptom triad of fever, buttock pain, and limping gait, along with characteristic findings in magnetic resonance imaging (MRI) and bone scans, and recovered fully after 6 weeks of antimicrobial therapy. Pyogenic sacroiliitis is an uncommon disease in which the diagnosis is often delayed because of nonspecific clinical presentation. The key to successful management is early diagnosis in which MRI and bone scan findings play a crucial role. If the diagnosis is established promptly, most patients can be managed successfully following the therapeutic principles used in other osteoarticular infections.

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“…The diagnosis is often initially overlooked because of poorly localising initial symptoms, the relative rarity of the disorder, the physician's low suspicion and inaccurate physical examination [5]. The pathophysiology of PS is presumed to be the haematogenous spread of bacteria but, in the majority of cases, no primary source is identified [6].…”

Section: Ps Pyogenic Sacroiliitis Si Sacroiliacalmentioning

confidence: 99%

Pyogenic sacroiliitis in a 14-year-old girl

et al. 2006

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Abbreviations PS Pyogenic sacroiliitis SI SacroiliacalPyogenic sacroiliitis (PS) is an uncommon joint infection. Clinical presentation may be misleading, since it can resemble more common conditions such as sciatica, acute abdomen or septic arthritis of the hip.We report a 14-year-old girl with PS. She presented at another hospital with fatigue and a six-day history of progressive low back pain radiating down to the right knee. Plain X-ray examination and computed tomography (CT) scans of the spine were normal. She was discharged with analgesic therapy. As she developed high fever over 40°C, worsening pain and immobility, she was admitted to our emergency department. Although the temperature at that moment was only 37.2°C, she appeared ill. The right sacroiliac joint and buttock were tender. Internal and external rotation, extension and flexion of the hip were decreased and painful. Compression of the sacroiliac joint was very painful. Further clinical examination was normal.Blood examination revealed an erythrocyte sedimentation rate of 54 mm/hour and a C-reactive protein (CRP) of 16.5 mg/dl (normal<0.5 mg/dl). Blood cultures were negative.Bone scintigraphy revealed increased uptake of 99m Tc-MDP in the right sacroiliac joint, suggesting sacroiliitis. This was confirmed by magnetic resonance imaging (MRI). There was oedema of the ileum and infiltration of the surrounding soft tissues anterior of the sacroiliac joint, with an inflammatory fluid collection extending to the pre-sacral region. Intravenous flucloxacillin treatment was started. The fever disappeared within 2 days and the pain diminished. By day 7, the CRP had fallen to 0.5 mg/dl. Follow-up MRI examination on day 9 showed beginning resolution of the collection and the infiltration of the surrounding soft tissues. She was then switched from intravenous to oral antibiotherapy and discharged. Oral flucloxacillin was continued for 6 weeks.Pyogenic sacroiliitis accounts for 1.5% of all joint infections [6]. The diagnosis is often initially overlooked because of poorly localising initial symptoms, the relative rarity of the disorder, the physician's low suspicion and inaccurate physical examination [5]. The pathophysiology of PS is presumed to be the haematogenous spread of bacteria but, in the majority of cases, no primary source is identified [6]. Predisposing risk factors in adults are intravenous drug abuse and infections of the skin, respira-

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Osteomyelitis and pyogenic sacroiliitis: A difficult diagnosis

Cited by 28 publications

References 8 publications

Pyogenic Sacroiliitis in Children: Two Case Reports

Pyogenic Sacroiliitis in Children: Two Case Reports

Pneumococcal sacroiliitis in a 4‐year‐old boy

Pyogenic sacroiliitis in a 14-year-old girl

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