Pyogenic Sacroiliitis in a 13-Month-Old Child

Abstract

Pyogenic sacroiliitis is exceptional in very young children. Diagnosis is difficult because clinical examination is misleading. FABER test is rarely helpful in very young children. Inflammatory syndrome is frequent. Bone scintigraphy and MRI are very sensitive for the diagnosis. Joint fluid aspiration and blood cultures are useful to identify the pathogen. Appropriate antibiotic therapy provides rapid regression of symptoms and healing. We report the case of pyogenic sacroiliitis in a 13-month-old child.Clinical, biological, and imaging data of this case were reviewed and reported retrospectively.A 13-month-old girl consulted for decreased weight bearing without fever or trauma. Clinical examination was not helpful. There was an inflammatory syndrome. Bone scintigraphy found a sacroiliitis, confirmed on MRI. Aspiration of the sacroiliac joint was performed. Empiric intravenous biantibiotic therapy was started. Patient rapidly recovered full weight bearing. On the 5th day, clinical examination and biological analysis returned to normal. Intravenous antibiotic therapy was switched for oral. One month later, clinical examination and biological analysis were normal and antibiotic therapy was stopped.Hematogenous osteoarticular infections are common in children but pyogenic sacroiliitis is rare and mainly affects older children. Diagnosis can be difficult because clinical examination is poor. Moreover, limping and decreased weight bearing are very common reasons for consultation. This may delay the diagnosis or refer misdiagnosis. Bone scintigraphy is useful to locate a bone or joint disease responsible for limping. In this observation, bone scintigraphy located the infection at the sacroiliac joint. Given the young age, MRI was performed to confirm the diagnosis. Despite the very young age of the patient, symptoms rapidly disappeared with appropriate antibiotic therapy.We report the case of pyogenic sacroiliitis in a 13-month-old child. It reminds the risk of misdiagnosing pyogenic sacroiliitis in children because it is exceptional and clinical examination is rarely helpful. It also highlights the usefulness of bone scintigraphy and MRI in osteoarticular infections in children.

A case report of pyogenic sacroiliitis in a 9-month-old child

“…Pyogenic sacroiliitis is a very rare under-recognized osteo-articular infection in the pediatric age group which usually affects children of the older age group [ 1 , 2 ]. It is quite exceptional to occur at a young age such as 9 months [ 12 ].…”

“…A very rare condition, pyogenic sacroiliitis is responsible for 1-2% of all osteoarticular infections in children [ 1 , 2 ]. Diagnosis is often delayed due to non-specific signs and symptoms during presentation, difficulty in assessing the joint, more common differential diagnosis and low yield diagnostic findings in conventional radiography [ 3 , 4 ].…”

Management of Instability following Pyogenic Sacroiliitis: Technical Case Report

“…Long-term outcome is lacking in most of the series and case reports [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Chronic SI-joint pain is reported in a high proportion of cases (33% to 43.5%) [3,22,23]. The cause of the pain has not been investigated in retrospective studies.…”

“…Arthrodesis is normally reserved as a salvage procedure in case of ineffective conservative therapy or by severity criteria as septicaemia or neurological deficits in the acute phase or secondary instability due to joint destruction in the chronic phase of the infection. The most appropriate surgical regime is still discussed controversially in the literature: open procedure for extensive debridement and fusion of the joint are described in some series as a current approach [1,2,22]. The surgical approach can be posterior, anterior, or mixed, depending on the location of the abscess on the MRI.…”

Pyogenic Sacroiliitis in a 13-Month-Old Child

“…In the article “Pyogenic Sacroiliitis in a 13-Month-Old Child: A Case Report and Literature Review”, 1 which appeared in Volume 94, Issue 42 of Medicine , the author's names were incorrectly transposed in the byline. The article has since been corrected online.…”