Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report.

Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection. The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal. During hospitalization, initial antibiotic therapy was prescribed. After Mycobacterium tuberculosis was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18-24 months, in addition to daily vitamin B6 and pantoprazole. LEARNING POINTS: After confirmation of tuberculosis (TB), a 4-drug anti-TB therapy was administered for 18-24 months, together with daily vitamin B6 and pantoprazole.After 2 years of follow-up, MRI showed significantly reduced signal intensity of bone and soft tissue, but the size of the complex did not change in the sacroiliac joint.

[Tuberculous sacroiliitis: about two cases]. / Sacroillite tuberculeuse: à propos de deux cas.

Tuberculous sacroiliitis is rare and of difficult diagnosis. We here report two cases. The first patient was a 40-year old woman with HIV infection; the diagnosis was based on histological evaluation after surgical biopsy. The second patient was a 25-year old man living in prison whose diagnosis was established on the basis of clinical, biological, radiological reasonings and of the effectiveness of the treatment; tuberculin intradermal reaction was phlyctenular. CT scan was essential to establish the lesion diagnosis by showing edge erosion and soft tissue abscess The patients received medical and anti-tuberculosis treatment.

Tuberculous Sacroiliitis

Tuberculosis can affect the sacroiliac joint. The involvement has been reported in up to 10 percent of patients with osteoarticular tuberculosis. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. Lack of awareness of this presently uncommon form of infection often leads to diagnostic delay and increased morbidity. Early diagnosis and proper treatment with anti-tuberculous medication could obtain a satisfactory functional outcome. We report a case of tuberculous sacroiliitis in a 21 year-old male patient including his clinical presentation, radiographic features and outcome of medical treatment.