PYOGENIC INFECTION OF THE SACROILIAC JOINT

Background: This review was undertaken to examine a collected series of patients with this uncommon condition. Method: Six definite and three possible cases of pyogenic infection of the sacroiliac joint are reported. Their manner of presentation, investigations, management and outcome are discussed in conjuction with a review of the literature. The patients were identified by searching the medical records of three hospitals over a 10 year period and the clinical data were analysed retrospectively. Results: All patients were clinically tender over the involved sacroiliac joint and were experiencing fever. Technetium‐99m bone scans demonstrated increased uptake in the sacroiliac joint in all patients, although two scans were initially negative. Plain pelvic radiographs, computed tomography scans and white cell counts were generally unhelpful in initially establishing the diagnosis. Blood cultures were positive in eight cases, and Staphylococcus aureus was isolated. There were four women and five men with an average age of 25 years. Six reported recent respiratory tract or skin infections. Two of these had also reported an episode of minor pelvic trauma in the preceding 2 weeks. A further two patients were intravenous drug users. Treatment was bed rest and antibiotics in all cases and marked initial improvement was seen. The outcome was variable, with a significant proportion reporting discomfort on the affected side after heavy exercise many years after the infection. Conclusion: The importance of a thorough clinical assessment and suspicion of the diagnosis of this uncommon illness is emphasized.