A rare case presentation of septic sacroiliitis caused by staphylococcus xylosus and complicated with abscess formation: A case report.

Septic sacroiliitis is one of the infectious causes of sacroiliitis and it is seen rarely. In current literature, cases of septic sacroiliitis caused by several microorganisms have been reported so far. This case report presents the first case of septic sacroiliitis caused by Staphylococcus xylosus and also complicated with an abscess formation.

[Clinical and imaging characteristics of 110 patients with infectious sacroiliitis].

Objective: To investigate the clinical and imaging characteristics of infectious sacroiliitis. Methods: A total of 110 patients diagnosed with infectious sacroiliitis were retrospectively analyzed between 2008 and 2017.Clinical manifestations and therapeutic responses, laboratory tests such as HLA-B(27), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), T cell spot test for tuberculosis infection(TB-SPOT), Brucella agglutination test ect., blood culture of pathogens, pathological findings as well as magnetic resonance imaging were all recorded and analyzed. Results: Among the 110 patients, the male to female ratio was 44 to 66 with an average age 15-58(29.4±10.8) years and the course of disease 0.3-60 (5.7±13.2) months. As to the pathogens, 71 cases were pyogenic, 24 cases with tuberculous sacroiliitis, and 15 cases were brucellosis infections. The majority of patients (97.3%) had unilateral sacroiliac joint involvement. Ten (9.1%) patients suffered infectious sacroiliac arthritis after delivery. Hip pain was the main clinical manifestation (83/110,75.5%) and fever as the second (77/110,70.0%). HLA-B(27) was positive in 11 patients (10.0%). Both ESR and CRP were elevated in the majority. There were 103 patients receiving sacroiliac joint puncture biopsy. Seven patients were diagnosed through blood culture or brucellosis agglutination test. Bone marrow edema and osteolytic lesions in magnetic resonance imaging (MRI) were more common in pyogenic or tuberculous sacroiliitis than in brucellosis infections. Conclusion: Infectious sacroiliitis should be differentiated from spondyloarthritis, which develops more in female patients, with short disease duration and fever, mostlynegative HLA-B(27). The majority patients present unilateral sacroiliitis. Active inflammatory lesions are usually beyond sacroiliac joints with osteolytic changes in MRI examinations.

Disseminated Cryptococcosis After Liver Transplant: A Case Report.

Cryptococcosis is an opportunistic infection caused by the Basidiomycota Cryptococcus neoformans (Cryptococcus gattii), which affects immunosuppressed patients and less frequently immunocompetent patients. Solid-organ transplant recipients are a particularly high-risk group, depending on the net state of immunosuppression. In these patients, the infection usually appears after the first year after transplant, although it may occur earlier in liver transplant recipients. In most cases, the infection is secondary to the reactivation of a latent infection, although it may be due to an unidentified pretransplant infection by primary infection. Less frequently, it may be transmitted by the graft. The lung and central nervous system are most frequently involved. Extrapulmonary involvement is seen in 75% of the cases, and disseminated disease occurs in 61%, with mortality ranging from 17% to 50% when the central nervous system is involved. Here, we report a case of disseminated cryptococcosis (lymphadenitis, meningitis, pulmonary nodules, and possibly sacroiliitis) in a patient after liver transplant, with good clinical and microbiological outcomes and without relapse.

Sacroileítis piógena: Lecciones aprendidas de una serie de casos atípicos / Pyogenic sacroiliitis: Lessons learned from an atypical case series

Introducción: La sacroileítis piógena (SIP) es una entidad infrecuente que representa del 1 al 2% del total de las infecciones articulares en la edad pediátrica. Su diagnóstico a menudo se complica y retrasa debido a la inespecificidad de sus síntomas, signos y exploración física. Además, la identificación microbiológica puede resultar difícil debido a la alta proporción de hemocultivos negativos y los riesgos implicados en la aspiración de líquido articular en esta localización. Pacientes y métodos: Revisión retrospectiva de las historias clínicas de todos los pacientes menores de 18 años ingresados en un hospital infantil terciario con SIP en el período 2008-2016. Resultados: Se identificaron 6 casos de SIP en niños. Los hemocultivos fueron negativos, y la identificación del agente etiológico requirió aspiración de líquido sinovial en un paciente con infección por Aggregatibacter aphrophilus y pruebas específicas para la detección de agentes menos frecuentes en los pacientes restantes: Kingella kingae (n = 2), Brucella melitensis (n = 1) y Bartonella henselae (n = 1). Los pacientes recibieron regímenes de antibioterapia específica, y todos presentaron una evolución favorable y libre de secuelas durante el seguimiento. Conclusiones: A pesar del reducido tamaño muestral, nuestro estudio puso de relieve la baja efectividad del hemocultivo en el diagnóstico de la SIP pediátrica. También evidenció la necesidad de mantener un elevado índice de sospecha de los agentes atípicos y de emplear precozmente métodos diagnósticos apropiados, como las pruebas de imagen y la reacción en cadena de la polimerasa (PCR) en muestras de sangre, así como la prescripción de antibioterapia efectiva

Introduction: Pyogenic sacroiliitis (PSI) is a rare condition that amounts to 1% to 2% of all joint infections in the paediatric age group. Its diagnosis is often difficult and delayed due to its nonspecific signs, symptoms and physical findings. Also, the identification of the causative microorganism is frequently challenging due to a high proportion of negative blood cultures and the risks involved in joint aspiration in this site. Patients and methods: We performed a retrospective review of the health records of all patients aged less than 18 years admitted to a tertiary children's hospital due to PSI between 2008 and 2016. Results: We identified 6 cases of paediatric PSI. The blood cultures were negative, and the identification of the causative agent required joint fluid aspiration in one patient with infection by Aggregatibacter aphrophilus, and specific screening tests for less frequent agents in the other patients: Kingella kingae (n = 2), Brucella melitensis (n = 1) and Bartonella henselae (n = 1). The patients were treated with specific antimicrobial regimens, and all had favourable clinical outcomes and were free from sequelae during the follow-up. Conclusions: Despite the small sample size, our study evinced the low effectiveness of blood cultures for diagnosis of paediatric PSI. It also highlights the need for a high level of suspicion for atypical agents and the early use of adequate diagnostic methods, including imaging and serological testing or polymerase chain-reaction (PCR) analysis of blood samples, as well as prescription of effective antimicrobial therapy

[Pyogenic sacroiliitis: Lessons learned from an atypical case series]. / Sacroileítis piógena: Lecciones aprendidas de una serie de casos atípicos.

INTRODUCTION: Pyogenic sacroiliitis (PSI) is a rare condition that amounts to 1% to 2% of all joint infections in the paediatric age group. Its diagnosis is often difficult and delayed due to its nonspecific signs, symptoms and physical findings. Also, the identification of the causative microorganism is frequently challenging due to a high proportion of negative blood cultures and the risks involved in joint aspiration in this site. PATIENTS AND METHODS: We performed a retrospective review of the health records of all patients aged less than 18 years admitted to a tertiary children's hospital due to PSI between 2008 and 2016. RESULTS: We identified 6 cases of paediatric PSI. The blood cultures were negative, and the identification of the causative agent required joint fluid aspiration in one patient with infection by Aggregatibacter aphrophilus, and specific screening tests for less frequent agents in the other patients: Kingella kingae (n=2), Brucella melitensis (n=1) and Bartonella henselae (n=1). The patients were treated with specific antimicrobial regimens, and all had favourable clinical outcomes and were free from sequelae during the follow-up. CONCLUSIONS: Despite the small sample size, our study evinced the low effectiveness of blood cultures for diagnosis of paediatric PSI. It also highlights the need for a high level of suspicion for atypical agents and the early use of adequate diagnostic methods, including imaging and serological testing or polymerase chain-reaction (PCR) analysis of blood samples, as well as prescription of effective antimicrobial therapy.

Pyogenic sacroiliitis: A rare complication of inflammatory bowel disease.

Although sacroiliitis is not uncommon in patients with inflammatory bowel diseases (IBD), bacterial infection of the sacroiliac joint is rare. The diagnosis is often delayed because of low clinical suspicion, a vague clinical picture and poorly defined localization of symptoms. We report a case of pyogenic sacroiliitis in a patient with Crohn's disease caused by Clostridia spp. and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness.

Septic Sacroiliitis in a 53-Year-Old Adult: A Case Report.

A 53-year-old woman with no significant medical history presented with 10/10 right buttock pain that radiated to the right groin. With no reported recent injury, the absence of fever, and no identifiable risk factors, an infectious etiology, including septic sacroiliitis (SSI), is at the end spectrum of the differential. SSI is a rare condition with nonspecific findings that can lead to major complications, including death. To our knowledge, there are only 4 recent major literature reviews on SSI, with most cases reported to have at least 1 risk factor or clinical sign indicating the possibility of an infectious etiology. The patient reported in this case had no identifiable risk factors; therefore, high clinical suspicion is needed to prevent debilitating consequences from prolonged infection. LEVEL OF EVIDENCE: V.

Magnetic resonance imaging findings of infectious sacroiliitis associated with iliopsoas abscess: a case report in a young male.

Infectious sacroiliitis is an infection of the sacroiliac joint, not easy to diagnose because of its non-specific signs, symptoms and laboratory abnormalities. We describe a case of a 16 year-old male with 5 days' history of fever, abdominal pain, constipation, low-back and left hip pain extended to the left knee associated with sudden inability to walk. In the first place, magnetic resonance imaging (MRI) examination of his sacroiliac joint revealed an enlarged corpuscolated fluid collection near the left iliopsoas muscle, extended to homolateral paravertebral muscles and a little fluid at the left sacroiliac joint. Drainage by aspiration of the iliopsoas abscess was applied; Staphylococcus aureus was found in the aspirated fluid and isolated from the blood too. Therefore intravenous antibiotic therapy was begun. Follow-up MRI exams confirmed the muscle abscess and revealed also a spongy bone edema of the left sacroiliac joint, persisting despite the disappearance of symptoms and the normalization of inflammatory values. It is important to make an early diagnosis of infectious sacroiliitis in order to begin antibiotic therapy as soon as possible, because of the increasing morbidity of infection of sacroiliac joint. In our case MR findings have provided significant orientation towards the final diagnosis of infectious sacroiliitis.

Tuberculous sacroiliitis in a patient with systemic lupus erythematosus: a case report and literature review.

Systemic lupus erythematosus (SLE) patients are at higher risk of developing opportunistic infections such as tuberculosis (TB), especially extrapulmonary forms like osteoarticular TB, compared to the general population. However, tuberculous sacroiliitis has been scarcely reported in these patients. We present a 34-year-old woman with SLE who developed articular tuberculosis simultaneously affecting the right sacroiliac joint and the left knee. The patient was successfully treated with antituberculosis therapy for nine months. In this case, in addition to the immunological abnormalities of lupus, the long-term glucocorticoid therapy at high dosages was the main risk factor for the development of osteoarticular tuberculosis.

Strongly positive anti-CCP antibodies in patients with sacroiliitis or reactive arthritis post-E. coli infection: A mini case-series based review.

We report here on four cases of patients with strongly positive anti-citrullinated cyclic peptides (anti-CCP) antibodies and clinical features of seronegative spondyloarthritis (SpA) and reactive arthritis. The four patients had various clinical presentations: one had an initial diagnosis of seropositive rheumatoid arthritis (RA) with involvement of the sacroiliac joints (similar to previous reports of the association of two diseases); one had a clinical picture of reactive arthritis following an episode of an Escherichia coli positive urinary tract infection; and two had asymmetrical sacroiliitis (SII), but no evidence of peripheral joint involvement (never reported before). In all cases, high titers of anti-CCP antibodies were found. We present a comparison of the clinical manifestations, radiographic features and treatment regimens of these cases. Our report supports previous literature data of possible overlap existing between RA and SpA, but also presents for the first time the association of high titers of anti-CCP antibodies with SII and reactive arthritis in patients with no peripheral small joint involvement.

A Rare Case of Isolated Salmonella Species Group B Sacroiliitis in a Healthy Collegiate-Level Swimmer: A Case Report.

CASE: We present a case of isolated Salmonella species group B sacroiliitis in a healthy 19-year-old collegiate-level swimmer with no known risk factors. To our knowledge, there are no similar cases described in the current literature. CONCLUSION: Pyogenic sacroiliitis (PS) is a rare form of septic arthritis, especially in adults. PS is most commonly seen in the setting of intravenous drug use or in an immunocompromised patient. If a patient does not fit either of these demographics, PS initially can be a difficult diagnosis because of its rarity and vague symptomatology.

Unilateral infective sacroiliitis in a boy presenting with a limp.

A 9-year-old boy admitted to a district general hospital with a 1-week history of fever and a 2-day history of right hip pain. Initial workup revealed raised inflammatory markers and unremarkable imaging studies. After clinical review, there was minimal improvement of the patient's condition 5 days after presentation; therefore, an MRI of the pelvis/hips was carried out, which supported a clinical diagnosis of right-sided infective sacroiliitis. Infective sacroiliitis is rare and only represents 1%-2% of septic arthritis in children. The condition still remains a diagnostic challenge first due to poor localisation of symptoms with referred pain to the hip, thigh and lower back and second due to a lack of awareness by non-specialist clinicians. Early diagnosis is a key to avoid sequelae such as an abscess, degenerative changes of the sacroiliac joint and can be achieved by a thorough clinical examination, monitoring inflammatory markers and MRI.

Aggregatibacter aphrophilus Sacroiliitis Following Gastroscopy in a Young Sportsman.

We report a case of Aggregatibacter aphrophilus sacroiliitis in a young sportsman, presenting 48 hours after endoscopy and biopsy. Microbiological diagnosis was made only after repeated attempt at joint aspiration. The patient was cured after radiologically guided drainage and a prolonged course of directed antibiotics.

Pediatric Sacroiliitis: Clinical and Microbiologic Differences Between Infants and Children-Adolescents.

BACKGROUND: The aim of this study was to improve knowledge of pediatric pyogenic sacroiliitis (PSI) in the pediatric population based on a consecutive case series. METHOD: We conducted a single-center cross-sectional study on 16 patients admitted to the emergency department of our Hospital between January 1990 and December 2015 with a confirmed diagnosis of PSI. The patients were divided into 2 groups by age: infants (6 months to 4 years) and children-adolescents (4-16 years). The features of PSI, clinical signs and symptoms, laboratory tests, bacteriologic investigations, radiologic examinations and outcome were compared among the 2 groups. RESULTS: Patients in the children-adolescent group usually presented with a history of limping and buttock or lower back pain, and methicillin-susceptible Staphylococcus aureus was the most frequent pathogen. We observed a second peak of incidence of PSI in infants with consistent difference in clinical and microbiologic presentation. Infants were more likely to have an ambiguous onset with the refusal to bear weight as the only consistent clinical manifestations, and biologic investigations demonstrated higher erythrocyte sedimentation rate and platelet counts. However, all blood and joint fluid cultures were sterile in the infant group. CONCLUSION: PSI in infants and adolescents may represent 2 different conditions. Although PSI is mainly caused by S. aureus in the children-adolescent group, clinical manifestations and biologic characteristics of PSI in infants suggest Kingella kingae as the etiology osteoarticular infection. Thus, oropharyngeal swab polymerase chain reaction assay for K. kingae and magnetic resonance imaging should be considered for early diagnosis and treatment of this condition in the younger age group.

Infectious Postpartum Sacroiliitis: The Importance and Difficulty of Early Diagnosis.

The sacroiliitis accounts for about 1.5% - 10% of all cases of septic arthritis and it is strongly associated with gynaecological infections, pelvic trauma or drug abuse (3.4% - 12.8% of cases occur during the postpartum period). Early diagnosis is difficult because the symptoms are nonspecific in pregnancy and in the postpartum period, making the delay of treatment a serious risk of irreversible damage to the joint and development of post-infectious complications. The authors describe the case of a 37-year-old puerperal woman presented to hospital, weeks after urgent caesarean section, with endometritis, post-anesthetic epidural hematoma and secondary infectious postpartum sacroiliitis. The diagnosis of sacroiliac joints pathology during pregnancy and puerperium is challenging. The pathogenesis of infectious sacroiliitis results from local contamination by contiguous infection or hematogenous spread of bacterial infections. The prognosis is usually favorable and depends on early diagnosis and treatment.

A sacroileíte representa 1,5% - 10% de todos os casos de artrite séptica e está fortemente associada a infecções ginecológicas, trauma pélvico e a abuso de drogas (3,4% - 12,8% dos casos ocorrem durante o puerpério). O diagnóstico precoce é difícil, pois os sintomas são inespecíficos na gravidez e no puerpério, retardando o tratamento, podendo assim causar danos irreversíveis à articulação e desenvolvimento de complicações pós-infecciosas. Os autores descrevem o caso de uma puérpera de 37 anos que duas semanas após realização de cesariana urgente iniciou quadro de endometrite, hematoma epidural secundário a complicação anestésica e sacroileíte infecciosa secundária. O diagnóstico de patologia da articulação sacroilíaca durante a gravidez e puerpério constitui um desafio. A patogénese da artrite séptica resulta da contaminação local por infecção contígua ou da disseminação hematogénea. O prognóstico da sacroileíte infecciosa do pós-parto é geralmente favorável e depende do diagnóstico e tratamento precoces.

[Infectious sacroiliitis in tunisian centre: retrospective study of 25 cases]. / Sacroiliites infectieuses dans le centre tunisien: étude rétrospective de 25 cas.

Infectious sacroiliitis are rare but they can be complicated by disabling functional sequelae. To describe the clinical and bacteriological characteristics of infectious sacroiliitis among patients treated in Sousse Medical Center, Tunisia. A retrospective, descriptive study, of infectious sacroiliitis among patients hositalized in Sousse between 2000 and 2015. The diagnosis was made on the basis of medical signs, imaging, microbiological indicators. In the study were enrolled twenty five patients, 10 men and 15 women; the average age was 41 years (19-78). Sacroiliitis were due to pyogenic bacteria in 14 cases (56%), brucella bacteria in 6 cases (24%) and tuberculosis bacteria in 5 cases (20%). The mean duration of symptoms was 61, 45 and 402 days respectively. The most common clinical signs were buttock pain (92%) and fever (88%). Standard radiographic evaluation was abnormal in 75% of cases. CT scan and MRI of the sacroiliac joints was performed in all cases. The diagnosis was bacteriologically confirmed in 24 cases (96%). The average duration of antibiotic treatment was 83 days in the pyogenic sacroiliitis, and 102 days in brucellar sacroiliitis. The evolution was favorable in 12 patients (48%), 9 patients (36%) had sequelae of sacroiliac joint pain and 4 patients (16%) died. In our study, time frame of infectious sacroiliitis evolution did not predict the causative bacterium, hence the need for bacteriological documentation in order to prescribe appropriate antibiotic therapy.