Septic shock in pregnancy due to pyogenic sacroiliitis: a case report

Abstract

IntroductionLower back pain due to sacroiliac joint dysfunction is a common symptom during pregnancy. However, infection of the sacroiliac joint is rare, even more so if no predisposing factors are present.Case presentationAfter the onset of unspecific acute pain in the left buttock region, a 31-year-old pregnant woman developed septic shock due to pyogenic sacroiliitis. The medical and obstetric management, treatment applied and patient's experience are described.ConclusionThe correct diagnosis and treatment of pyogenic sacroiliitis during pregnancy may avoid joint and bone destruction in addition to maternal and fetal complications.

Infectious Postpartum Sacroiliitis: The Importance and Difficulty of Early Diagnosis

“…The most frequently isolated organism is Staphylococcus aureus, 1,6 most often methicillin-sensitive, but cases have been described of infections caused by Streptococcus spp., another Staphylococcus spp., [1][2][3][4][5][6][7][8][9][10][11] and one case of infection by Mycobacterium tuberculosis was identified. 3 Imagama et al (2014) described a case of infectious postpartum sacroiliitis caused by methicillin-resistant Staphylococcus aureus (MRSA).…”

“…8 The frequency of septic sacroiliitis in pregnant and puerperal women suggests that during the pregnancy and the postpartum period there are local and systemic factors that decrease the sacroiliac Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com joint' resistance, such as changes in pressures due to growth of the pregnant uterus, relaxation of the pelvic ligaments, trauma of delivery, and the context of pregnancy-induced immunosuppression. 7,[9][10][11] These changes may affect the microvasculature of the joint, leading to microscopic areas of injury on the joint surface, thus turning the periosteum more susceptible to bacterial invasion. 7,11 By analysis of published postpartum sacroiliitis cases (Table 1), the most common form of clinical presentation is fever, associated with pain in the buttock, with possible limping gait, and acute onset (up to one week after delivery).…”

“…7,11 By analysis of published postpartum sacroiliitis cases (Table 1), the most common form of clinical presentation is fever, associated with pain in the buttock, with possible limping gait, and acute onset (up to one week after delivery). [1][2][3][4][5][6][7][8][9][10][11] In the present case report, the clinical subacute onset (two weeks) might be related to treatment with corticosteroids in the suspected post-anesthetic epidural hematoma.…”

“…[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.…”

Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review

“…Osteoporosis in pregnancy has been associated with vertebral [48] and sacral stress fractures [60] . Other rare pathologies may include osteomyelitis [99] and spinal tumours [91,100] . A detailed account of the aetiology of low back and pelvic pain in pregnancy can be found in other publications [11,12] .…”