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      Septic sacroiliitis in the late postpartum due to Escherichia cóli Translated title: Sacroiliitis séptica por Escherichia cóli en el puerperio tardío

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          Abstract

          Septic sacroiliitis is an unusual condition, and due to its non-specific symptoms, the diagnosis is often delayed. It should be suspected in cases in which inflammatory back pain and systemic inflammatory signs co-exist, especially in people with risk factors, such as postpartum. The case is presented of a woman, who in the late postpartum, presented with sacroiliitis and severe sepsis due to Escherichia coli. This is the second report of a case of septic sacroiliitis due to E. coli associated with pregnancy.

          Translated abstract

          La sacroiliitis séptica es una condición inusual, a menudo el diagnóstico se hace de forma tardía debido a la poca especificidad de los síntomas. Debe ser sospechada en casos donde coexista dolor lumbar inflamatorio y signos de respuesta inflamatoria sistémica, especialmente en personas con factores de riesgo tales como el puerperio. En este artículo reportamos el caso de una mujer quien durante el puerperio tardío presentó sacroiliitis por Escherichia coli y sepsis grave secundaria, siendo este el segundo caso reportado de sacroiliitis séptica por Escherichia coli asociada al embarazo.

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          Most cited references55

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          Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

          Marion Hermet, Emeline Minichiello, René Flipo … (2012)
          Background Non-brucellar and non-tuberculous infectious sacroiliitis (ISI) is a rare disease, with misleading clinical signs that delay diagnosis. Most observations are based on isolated case reports or small case series. Our aim was to describe the clinical, bacteriological, and radiological characteristics of ISI, as well as the evolution of these arthritis cases under treatment. Methods This retrospective study included all ISI cases diagnosed between 1995 and 2011 in eight French rheumatology departments. ISI was diagnosed if sacroiliitis was confirmed bacteriologically or, in the absence of pathogenic agents, if clinical, biological, and radiological data was compatible with this diagnosis and evolution was favourable under antibiotic therapy. Results Overall, 39 cases of ISI were identified in adults, comprising 23 women and 16 men, with a mean age at diagnosis of 39.7 ± 18.1 years. The left sacroiliac joint (SI) was affected in 59% of cases, with five cases occurring during the post-partum period. Lumbogluteal pain was the most common symptom (36/39). Manipulations of the SI joint were performed in seven patients and were always painful. Mean score for pain using the visual analogue score was 7.3/10 at admission, while 16 patients were febrile at diagnosis. No risk factor was found for 30.7% of patients. A diagnosis of ISI was only suspected in five cases at admission. The mean time to diagnosis was long, being 43.3 ± 69.1 days on average. Mean C-reactive protein was 149.7 ± 115.3 mg/l, and leukocytosis (leukocytes ≥ 10 G/l) was uncommon (n = 15) (mean level of leukocytes 10.4 ± 3.5 G/l). Radiographs (n = 33) were abnormal in 20 cases, revealing lesions of SI, while an abdominopelvic computed tomography (CT) scan (n = 27) was abnormal in 21 cases, suggesting arthritis of the SI joints in 13 cases (48.1%) and a psoas abscess in eight. Bone scans (n = 14) showed hyperfixation of the SI in 13 cases. Magnetic resonance imaging (MRI) (n = 27), when focused on the SI (n = 25), directed towards the diagnosis to ISI in 25 cases. Pathogenic agents were isolated in 33 cases (84.6%) by means of articular puncture (n = 16), blood culture (n = 14), cytobacteriological examination of urine (n = 2), or puncture of the psoas (n = 1). Gram-positive cocci were the mostly isolated common bacteria, with a predominance of staphylococci (n = 21). The most frequently isolated gram-negative bacillus was Pseudomonas aeruginosa (n = 3). Evolution was favourable in 37 out of 39 patients under prolonged antibiotic therapy (mean duration 3.01 ± 1.21 months). Conclusion Our series confirmed that the clinical manifestations of ISI usually lead to delayed diagnosis. Based on our results, we suggest performing an MRI of the spine and SI in clinical situations characterised by lumbogluteal pain and symptoms of an infectious disease, such as fever.
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            Pyogenic infection of the sacroiliac joint. Case reports and review of the literature.

            J Vyskocil, M McIlroy, T Brennan … (1991)
            Three cases of pyogenic sacroiliitis are described, and the English literature from 1878 to 1990 reviewed, for a total of 166 cases. In 1 patient the source of infection was identified at the site of an intravenous line; 1 patient had 2 risk factors for developing the disease (pregnancy and intravenous drug use); and a third patient had no source of infection and no associated risk factors. The diagnosis of pyogenic sacroiliitis was made in each patient by history, physical examination, and positive skeletal scintigraphy or computed tomography of the sacroiliac joint. The infectious agent causing septic arthritis was identified by fine-needle aspiration of the sacroiliac joint under fluoroscopic guidance. Two of the 3 patients also had an open biopsy of the sacroiliac joint--one to confirm the organism causing septic arthritis, and the other for surgical drainage of the infected sacroiliac joint. Cultures from all 3 patients grew organisms uncommon for this disease, and all were treated for 6 weeks with intravenous antibiotics. In all patients pain diminished after treatment. Pyogenic sacroiliitis is a relatively rare condition (1-2 cases reported/year) that may be clinically difficult to diagnose unless the clinician is familiar with the disease. A prompt diagnosis can prevent significant morbidity and reduce serious complication. Major predisposing factors include intravenous drug use, trauma, or an identifiable focus of infection elsewhere, but 44% of patients have no predisposing or associated factors identified. Most patients present with an acute febrile illness with pain in the buttocks and pain on movement that stresses the affected sacroiliac joint. There is no specific blood test which points to the diagnosis of pyogenic sacroiliitis, although the erythrocyte sedimentation rate may be greater than 100 mm/hr. The diagnostic procedure of choice is bone scan with attention to the early perfusion phase, which usually localizes the affected sacroiliac joint. Unilateral involvement is the rule. In patients whose blood cultures fail to reveal a causative organism, fluoroscopic guided fine-needle aspiration of the sacroiliac joint under general anesthesia may help to identify the organism. If all cultures are negative, open biopsy of the sacroiliac joint may be required. Open biopsy should also be done if sequestration or an abscess is formed, or if the patient fails to respond to antibiotic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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              The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome.

              Curtis W Slipman, Elliot B. Sterenfeld, Larry Chou … (1998)
              To determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS). Prospective constructive cohort study using sacroiliac joint block (SIJB) as the diagnostic gold standard. Tertiary care center. Consecutive patients describing low back pain including the region of the sacral sulcus. Physical examination revealed a positive response to three provocative SIJ maneuvers, two of which had to be Patrick's test and pain with palpation over the ipsilateral sacral sulcus. All subjects underwent fluoroscopically guided SIJB. Response to SIJB was assessed with visual analog scale (VAS) ratings before and after the block. A reduction of the VAS rating by at least 80% was considered a positive response to SIJB. Fifty consecutive patients met our criteria and underwent SIJB. Thirty patients had positive response to SIJB, making up the positive SIJS group. Twenty patients had less than 80% pain reduction with SIJB and thus comprised the negative SIJS group. The positive predictive value of provocative SIJ maneuvers in determining the presence of SIJS is therefore 60%. Our results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.
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                Author and article information

                Contributors
                Francisco Carvajal-Flechas: Role: ND
                Juan Camilo Sarmiento-Monroy: Role: ND
                Adriana Rojas-Villarraga: Role: ND
                Rubén-Darío Mantilla-Hernández: Role: ND
                Journal
                Journal ID (publisher-id): rcre
                Title: Revista Colombiana de Reumatología
                Abbreviated Title: Rev.Colomb.Reumatol.
                Publisher: Asociación Colombiana de Reumatología (Bogotá, Distrito Capital, Colombia )
                ISSN (Print): 0121-8123
                Publication date (Print and electronic): April 2016
                Volume: 23
                Issue: 2
                Pages: 131-136
                Affiliations
                [02] Bogotá D.C orgnameClínica del Country orgdiv1Servicio de Reumatología Colombia
                [03] Bogotá D.C orgnameFUNINDERMA orgdiv1Fundación para la Investigación en Dermatología y Reumatología Colombia
                [01] Bogotá D.C orgnameUniversidad del Rosario orgdiv1Facultad de Medicina Colombia
                Article
                Publisher ID: S0121-81232016000200010
                SO-VID: 8ef495a9-ccbc-44a8-aa80-ffadaf1ea0ad
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Date received : 04 August 2015
                Date accepted : 18 December 2015
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 56, Pages: 6
                Product

                SciELO Colombia


                Keywords: Sacroiliitis,Escherichia coli,Periodo de posparto,Articulación sacroilíaca,Artritis infecciosa,Postpartum period,Sacroiliac joint,Septic arthritis
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                Keywords: Sacroiliitis, Escherichia coli, Periodo de posparto, Articulación sacroilíaca, Artritis infecciosa, Postpartum period, Sacroiliac joint, Septic arthritis

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