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Acute unilateral sacroiliitis mimicking infection on magnetic resonance imaging with response to nonsteroidal antiinflammatory drugs: a distinct presentation of spondyloarthritis?

Dubash S, et al.

J Rheumatol. (2018); 45(12):1708–10

This case series describes four male patients (3 aged 19 years, 1 aged 41 years) with acute onset of unilateral non-infectious sacroiliitis that simulated septic arthritis. All patients had a rapid onset of symptoms from 2 to 30 days before presentation with MR findings of unilateral “florid” edema-like marrow signal involving >75% of the sacroiliac (SI) joint in 3 patients and between 25% and 75% in one. Soft tissue edema surrounded the affected SI joint on all MR studies. Acute phase serum markers were elevated in all patients with C-reactive protein levels between 15 mg/L and 262 mg/L. Two patients had fever at presentation and one had a sore throat and an elevated white blood cell count. Septic sacroiliitis was suspected and image-guided SI joint...

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