Sacroilitis: an unusual cause for a common presentation

Abstract

Inflammatory arthritis and sacroilitis are common presentations to rheumatology clinics. Owing to the physiological changes of pregnancy, the first presentation can be post partum with back pain and an accompanying oligoarthritis or polyarthritis. We present a woman with lower back pain who demonstrated clinical and radiological features consistent with sacroilitis and an inflammatory arthritis but was found to have an unusual presentation of another common cause of arthritis.

Infectious Postpartum Sacroiliitis: The Importance and Difficulty of Early Diagnosis

“…[1][2][3][4][5][6][7][8][9][10][11] The pathogenesis of infectious sacroiliitis results from either direct extension from a local infection or via hematogenous spread of bacterial infections (endocarditis, sinusitis, urinary tract infections or postpartum endometritis). 1,2,9-11 The concomitant diagnosis of post-epidural anesthesia hematoma in this patient also raises the possibility that this post-anesthetic complication may compete for the differential diagnosis of low back pain and for the infectious source of sacroiliitis.…”

“…[1][2][3][4][5][6][7] A review published in 2013 by Bart et al presents 20 cases of infectious postpartum sacroiliitis 1 (including a review published by Almoujahed et al in 2003, of 15 cases). 2 After that, Nair et al (2013), 3 Park et al (2013), 4 Shaikh et al (2014), 5 Imagama et al (2015) 6 and Millwala et al (2015), 7 published another five cases.…”

“…[1][2][3][4][5][6][7] A review published in 2013 by Bart et al presents 20 cases of infectious postpartum sacroiliitis 1 (including a review published by Almoujahed et al in 2003, of 15 cases). 2 After that, Nair et al (2013), 3 Park et al (2013), 4 Shaikh et al (2014), 5 Imagama et al (2015) 6 and Millwala et al (2015), 7 published another five cases. Nair et al reported a rare case of postpartum tuberculous sacroiliitis, which has not been reported in the literature earlier (the patient completely recovered with antituberculous treatment) 3 and Millwala et al described a woman who received several sessions of acupuncture treatment during her gestation at the site of her sacroiliac joint for sciatica, which developed biopsy-confirmed sacroiliitis with methicillin-sensitive Staphylococcus aureus during the immediate postpartum period.…”

“…7 Table 1 shows the characteristics of cases of infectious postpartum sacroiliitis published in the literature since 1966 (search on PubMed/Medline with 'Postpartum period', 'Infectious sacroiliitis', 'Septic arthritis' and 'Septic sacroiliitis' -Medical Subject Headings [MeSH] terms). [1][2][3][4][5][6][7] Considering its rather unspecific symptoms during pregnancy and puerperium, the establishment of an early diagnosis is difficult, making the delay of treatment a serious risk of irreversible damage to the joint and development of post-infectious complications. 1,2,5,6 …”

“…[1][2][3][4][5][6][7] Considering its rather unspecific symptoms during pregnancy and puerperium, the establishment of an early diagnosis is difficult, making the delay of treatment a serious risk of irreversible damage to the joint and development of post-infectious complications. 1,2,5,6 …”