Pyogenic Sacroiliitis in Children: Two Case Reports

Abstract

Pyogenic sacroiliitis is rare and accounts for approximately 1-2% of osteoarticular infections in children. Considerable delay between presentation and diagnosis is recognized. Two cases of pyogenic sacroiliitis are described. The first case is a 28-month-old girl presented with acute onset of fever, pain in the left hip, and limpness. Computed tomography (CT), bone scans, and magnetic resonance imaging (MRI) of the pelvis showed characteristic findings of infectious sacroiliitis, and blood cultures were negatives. The second case is a 13-year-old girl presented with acute onset of fever, pain in the right hip, and buttock, with inability to walk. The diagnosis of pyogenic sacroiliitis was confirmed by bone scans, and CT of the pelvis and blood cultures have identified Proteus mirabilis. The two children recovered fully after 6 weeks of antimicrobial therapy. Pyogenic sacroiliitis is an uncommon disease in children. The key to successful management is early diagnosis in which CT, bone scans, and MRI findings play a crucial role. If the diagnosis is established promptly, most patients can be managed successfully with antimicrobial therapy.

An atypical limping teenager

“…Although the onset of disease seems to be insidious in two-thirds of patients,2 our patient presented after only 5 days of symptoms, which seems to be in accordance with a recent series described by Molinos Quintana et al 3…”

“…Although invasive procedures (such as CT-guided drainage) are not routinely recommended,2 3 the absence of response to initial broad spectrum intravenous antibiotherapy in our patient was felt to be a good indication for joint aspiration on day 2, to identify the likely pathogen.…”

“…The identified at risk groups remain immunosuppressed patients and patients with sickle cell disease, although risk factors have been identified, such as atopic dermatitis, insect bite, folliculitis and furunculosis 23 Previous pelvic trauma2 and physical effort1 seem to be predisposing factors as well.…”

“…The differential diagnosis can be very broad, including septic arthritis of the hip,2 3 acute lymphoblastic leukaemia, osteomyelitis and sickle cell crisis. Juvenile-onset spondyloarthritis should also be considered, as it can present as a monarthritis of the lower extremity involving the sacroiliac joint.…”

Unilateral infective sacroiliitis in a boy presenting with a limp

“…Specifically, the imaging modality helps to differentiate between signs of transient synovitis and an infective sacroiliitis. Ghedira Besbes et al 9 describe a similar case of a 13-year-old girl presenting with right hip pain and worsening mobility to the point where she was unable to bear weight. Plain hip radiograph and hip ultrasound were unremarkable until more sensitive imaging — a CT scan — revealed signs of inflammation of the right sacroiliac joint.…”