Rheumatology Advance Access originally published online on March 12, 2008
Rheumatology 2008 47(5):740-741; doi:10.1093/rheumatology/ken068
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Comment on: Pyogenic sacroiliitis—a comparison between paediatric and adult patients
Department of Rheumatology, Craigavon Area Hospital, Portadown, UK.
Correspondence to: E. McCausland, Craigavon Area Hospital – Rheumatology, 68 Lurgan Rd, Portadown BT63 5QQ, UK. E-mail: elisabethmccausland{at}hotmail.com
SIR, We note with interest a recent article on pyogenic sacroiliitis in the November issue of Rheumatology [1]. We agree that it is relatively rare with few cases reported in the literature and that this can lead to delays in diagnosis with subsequent severe complications [2, 3]. In light of this, we are keen to report two cases of pyogenic sacroiliitis that presented to a district general hospital within a 1-yr period (2005–06) and to emphasize the authors’ point that a more optimal diagnostic and treatment protocol should be promoted in the future [1].
The first case of a 14-yr-old boy underlines the consequences of a delay in diagnosis. He presented with hip/back pain and pyrexia. Plain X-rays and ultrasound of his ‘hip’ were normal. He subsequently went on to develop overwhelming sepsis of ‘unknown origin’ necessitating a prolonged intensive care stay. It was only during his recovery that repeat examination prompted an MRI scan (Fig. 1). He was given 4 weeks of IV antibiotics and 6 months of oral antibiotics.
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The second case was of a 20-yr-old girl, previously very well, who presented with buttock pain 3 days after being bitten on her toe by a horsefly. She was pyrexic with rigors and had severe pain on stressing her SI joint. An MRI scan showed fluid collections in the SI joint. The joint was washed out and she was treated with 3 weeks of IV antibiotics and 3 weeks of oral antibiotics.
Both patients had a CRP >200 mg/l with pyrexia and blood cultures positive for Staphylococcus aureus, although as illustrated by the study [1] this is not always the case. Neither of them had any definite predisposing factors, in keeping with reports that suggest that in up to 44% of cases there is no aetiological factor identified [2]. Diagnosis is often delayed because the clinical picture can be non-specific and the condition can mimic other conditions [4, 5]. This is compounded by difficulties with examination of the SI joints. In our two cases, plain X-ray films were non-diagnostic and only MRI imaging was definitive.
Therefore, in conclusion, both of these cases illustrate the key message of the article [1] that although uncommon, pyogenic sacroiliitis should be considered by physicians, in patients of all ages with back pain and fever, especially as it is a treatable condition with few long-term complications if appropriate treatment is initiated promptly [3].
Disclosure statement: The authors have declared no conflicts of interest.
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- Wu M-S, Chang S-S, Lee S-H, Lee C-C. Pyogenic sacroiliitis – a comparison between paediatric and adult patients. Rheumatology (2007) 46:1684–7.
[Abstract/Free Full Text] - Raman R, Dinopoulos H, Giannoudis PV. Management of pyogenic sacroilitis: an update. Curr Orthopaed (2004) 18:321–5.[CrossRef]
- Abbot GT, Carty H. Pyogenic sacroiliitis, the missed diagnosis? Br J Radiol (1993) 66:120–2.
[Abstract/Free Full Text] - Groves C, Cassar-Pullicino V. Imaging of bacterial infections of the sacroiliac joint. Radiologie (2004) 44:242–53.[CrossRef]
- Kadir SW, Jeurissen MEC, Franssen MJAM. Two young girls with pyogenic sacroiliitis. Ann Rheum Dis (2004) 63:1353–4.
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