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AB0854 Infectious Sacroiliitis: Clinical and Therapeutic Features (About 17 Cases)
  1. Z. Alaya1,
  2. N. El Amri1,
  3. F. Bellazreg2,
  4. K. Baccouche1,
  5. S. Belghali1,
  6. H. Zeglaoui1,
  7. N. Amara1,
  8. W. Hachfi2,
  9. A. Letaief2,
  10. E. Bouajina1
  1. 1Rheumatology department
  2. 2Department of Infectious Diseases, Hospital Farhat Hached, Sousse, Tunisia

Abstract

Background Bone and joint infections are polymorphic and can take various forms. Infectious sacroiliitis are a special rare form and a misleading diagnosis.

Methods This is a retrospective study of 17 cases of infectious sacroiliitis collected in department of Rheumatology and Infectious Diseases in Hospital Farhat Hached in Tunisia over a period of 21 years [1993-2013].

Results Our population consists of 10 women and 7 men with a mean age of 42.7 years [21-78 years]. Clinical signs of appeal were inflammatory buttock pain (n=17), low back pain (n=1), pseudo- radicular pain (n=2) and a major functional impairment (n=4). General symptoms observed were fever (n=15), night sweats (n=7) and deterioration of the general status (n=12). These symptoms were acute in 7 cases, subacute and chronic in 5 cases each. Comorbidities were diabetes (n=1) and hemodialysis (n=1). The inflammatory syndrome was missing in one case, and leukopenia was noted in 3 cases. Standard radiographs were normal in 6 cases. Soft tissue abscess were objectified by CT (n=5) and MRI (n=1). Contributing factors of sacroiliitis were urinary tract infection (n=7), genital infection (n=1), recent blood transfusion (n=1), intramuscular injection (n=1), skin infection (n=3) and pregnancy (n=4) (1 case of ongoing pregnancy, 1 case of peri -abortion and 2 cases of post- partum). In 6 cases, sacroiliitis was secondary to sepsis. The causative organisms were isolated in 13 cases by blood cultures (n=4), urinalysis (n=4), biopsy of the sacroiliac joint (n=1), biopsy of soft tissue abscess (n=3) and Wright serology (n=5). Identified germs were brucellosis (n=5), Staphylococcus aureus (n=4), Escherichia coli (n=4), Mycobacterium tuberculosis (n=2), Klebsiella pneumonia (n=1), Klebsiella oxytoca (n=1) and Pseudomonas aeruginosa (n=1). Associated osteoarticular infectious locations occurred in 5 cases. These were an infectious spondylitis (n=2), a symphysis pubis arthritis (n=2), a shoulder arthritis (n=1) and a hip bilateral arthritis (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in one case. The outcome was unfavorable in 2 patients who presented with septic shock.

Conclusions The diagnosis of infectious sacroiliitis should be considered in any febrile buttock pain, especially in case of some contexts (septicemia, urogenital infections, peri-partum ...).

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.5463

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