Tuberculous sacroiliitis. A case report and review of the literature

Abstract

Background: Infections of the musculoskeletal system are tuberculous in nature in 1-5% of cases. The sacroiliac joint is involved in 3-9.7%. We describe the case of a 32-year-old man with tuberculous sacroiliitis presented as a growing mass on the lateral aspect of his right proximal and mid-thigh. Open biopsy, histology, cultures and PCR established the diagnosis of tuberculosis.

Results: After surgical drainage of the abscess, the patient was administrated a triple antibiotic regimen for 12 months. Seven years postoperatively, the patient is disease-free with no functional limitation. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.

Fig. 1

Anteroposterior radiograph of the pelvis in a 27-year-old man, showing erosions of the right sacroiliac joint and demarcation of the cortex of the right ischial tuberosity

Fig. 2

Bone scintigraphy with ^99mTc MDP exhibiting increased radioisotope uptake at the right sacroiliac joint, the right trochanteric area and ischial tuberocity

Fig. 3

Preoperative anteroposterior radiograph of the pelvis showing destructive lesion of the right trochanter and right ischial tuberosity

Fig. 4

a Axial computer tomography image showing erosions of the articular surface of the right sacroiliac joint. b Axial CT-image depicting destruction at the right trochanter and ischial tuberocity. Soft tissue calcifications are delineated in both sites

Fig. 5

aCoronal T-2 weighted magnetic resonance image of the pelvis showing a soft tissue mass at the right hip and proximal thigh, associated with destruction and significant edema of the right trochanter. b Axial T-2 weighted magnetic resonance image showing a soft tissue mass of the right proximal thigh

Fig. 6

Postoperative anteroposterior radiograph of the pelvis 5 years after the treatment. The sacroiliac joint is spontaneously ankylosed; there are residual changes of the right trochanter and ischial tuberocity