Infectious Postpartum Sacroiliitis: The Importance and Difficulty of Early Diagnosis

Abstract

RESUMOA 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. Palavras-chave: Articulação Sacroilíaca; Artrite Infecciosa/diagnóstico; Hematoma Epidural Espinhal; Período Pós-Parto. ABSTRACTThe 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.

Clinical Practice Guidelines for Pelvic Girdle Pain in the Postpartum Population

“…Musculoskeletal and systemic causes can be differentiated by the presence of fever in the systemic cases. [38][39][40][41][42] Pain complaints in the anterior abdominal wall and/ or perineum in the postpartum period may also be associated with nonmusculoskeletal conditions. It is important to consider the presence of uterine rupture, umbilical hernia, infection, obstetric fistula, and/or incomplete delivery of the placenta as possible causes.…”

Multimodality Multisystem Imaging of Pregnancy-Related Changes: Featuring Neurologic, Cardiothoracic, Breast, Gynecologic, and Musculoskeletal Issues

“…Infectious sacroiliitis results from hematogenous spread of bacteria or by local contamination. 52 Radiographs are the first-line imaging modality for evaluation of the SI joints. Infectious sacroiliitis is suggested with unilateral SI joint space widening, subchondral erosions, and resorption.…”

“…Importantly, 3.4% to 12.8% of infectious sacroiliitis cases occur in the postpartum period. Infectious sacroiliitis results from hematogenous spread of bacteria or by local contamination 52 …”

Infectious Sacroiliitis as a Rare Postpartum Complication: A Case Report

“…Infectious sacroiliitis is a rare diagnosis that accounts for up to 10% of all cases of septic arthritis [1]. Predisposing factors include intravenous drug abuse, immune suppression, pregnancy, trauma, and an identifiable focus of infection elsewhere [2].…”

“…Predisposing factors include intravenous drug abuse, immune suppression, pregnancy, trauma, and an identifiable focus of infection elsewhere [2]. Infectious sacroiliitis can result from local contamination by contiguous infection or hematogenous spread from bacteriemia [1].…”