Clinical Rheumatology

, Volume 30, Issue 1, pp 107–113 | Cite as

Pyogenic sacroiliitis in children—a diagnostic challenge

  • Agueda Molinos Quintana
  • Beatriz Morillo Gutiérrez
  • M. Soledad Camacho Lovillo
  • Olaf NethEmail author
  • Ignacio Obando Santaella
Brief Report


Osteoarticular infections in paediatric patients are associated with significant morbidity. Pyogenic sacroiliitis is rare and accounts for approximately 1–2% of osteoarticular infections in children. Diagnosis of this disease has been difficult in the past due to its deep location and may be delayed due to the lack of specific clinical signs and symptoms. We identified 11 paediatric patients with clinical–radiological signs of pyogenic sacroiliitis during an 8-year period and observed an unusual cluster of four cases during the last 11 months. Early diagnosis was possible due to a reproducible clinical pattern as well as radiological evidences of infection using magnetic resonance imaging and/or bone scintigraphy; most patients having predisposing factors. Staphylococcus aureus was the sole causative agent identified. All patients including two children with associated muscle abscesses were managed conservatively with antibiotic therapy only and showed good clinical response with no sequelae during follow-up. An algorithm for the correct and prompt diagnosis of this pathology is proposed. Standardised optimal therapy remains to be defined.


Sacroiliac joint Magnetic resonance imaging Osteomyelitis Pyogenic 





  1. 1.
    Mustafa MM, Saez-Llorens X, McCracken GH Jr, Nelson JD (1990) Acute hematogenous pelvic osteomielitis in infants and children. Pediatr Infect Dis J 9:416–421CrossRefPubMedGoogle Scholar
  2. 2.
    Schaad Urs B, McCracken GH Jr, Nelson JD (1980) Pyogenic arthritis of the sacroiliac joint in pediatric patients. Pediatrics 66(3):375–379Google Scholar
  3. 3.
    Ford LS, Ellis AM, Allen HW, Campbell DE (2004) Osteomyelitis and pyogenic sacroiliitis: a difficult diagnosis. J Paediatr Child Health 40:317–319CrossRefPubMedGoogle Scholar
  4. 4.
    Doita M, Yoshiya S, Nabeshima Y et al (2003) Acute pyogenic sacroiliitis without predisposing conditions. Spine 28:384–389CrossRefGoogle Scholar
  5. 5.
    Liu XQ, Li FC, Wang JW, Wang S (2010) Postpartum septic sacroileiitis misdiagnosed as sciatic neuropathy. Am J Med Sci 339:292–295CrossRefPubMedGoogle Scholar
  6. 6.
    Wada A, Takamura K, Fujii T, Yanagida H, Surijamorn P (2008) Septic sacroiliitis in children. J Pediatr Orthop 28:488–492PubMedGoogle Scholar
  7. 7.
    Wu MS, Chang SS, Lee SH, Lee CC (2007) Pyogenic sacroiliitis: a comparison between paediatric and adult patients. Rheumatology 46:1684–1687CrossRefPubMedGoogle Scholar
  8. 8.
    Gutiérrez Macías A, Barreiro García G, Ribacoba Bajo L, Alonso JJ, Aguirre Errasti C (1993) Sacroileitis piógena. Presentación de diez casos. Rev Clin Esp 193:235–238PubMedGoogle Scholar
  9. 9.
    Haliloglu M, Kleiman MB, Siddiqui AR, Cohen MD (1994) Osteomyelitis and pyogenic infection of the sacroiliac joint. Pediatr Radiol 24:333–335CrossRefPubMedGoogle Scholar
  10. 10.
    Gorissen J, Wojciechowski M, Somville J, Huyghe I, Parizel PM, Ramet J (2007) Pyogenic sacroiliitis in a 14-year-old girl. Eur J Pediatr 166:263–264CrossRefPubMedGoogle Scholar
  11. 11.
    Obando I, Martin E, Alvarez-Aldean J, Chileme A, Baca M, Barrio F (1991) Group B Streptococcus pelvic osteomyelitis presenting as foot drop in a newborn ninfant. Pediatr Infect Dis J 10(9):703–705CrossRefPubMedGoogle Scholar
  12. 12.
    Perez A, Padilla E, Marco A, De Otero J, Bandiera D, Marimón I (2008) Pneumococcal sacroiliits in a 4-year-old boy. Scand J Rheumatol 37(4):310–312CrossRefPubMedGoogle Scholar
  13. 13.
    Arias Miranda IM, Quiroga Ruiz JM, López de Mesa C, García-Alcalde Fernández ML (2005) Sacroileítis piógena complicada con absceso de psoas y neumonía. Med Interna 22(12):608–609Google Scholar
  14. 14.
    Komatsu H, Nojiri H, Sogo T, INRI A, Sawa F, Fujisawa T (2009) Sacroiliitis infected with group A streptococcus in a child presenting with confusion and combativeness. J Infect Chemother 15(5):328–330CrossRefPubMedGoogle Scholar
  15. 15.
    Cieslak TJ, Ottolini MG, O’Neill KM, Lampe RM (1993) Staphylococcus aureus meningitis associated with pyogenic infection of the sacroiliac joint. South Med J 86(10):1175–1178CrossRefPubMedGoogle Scholar
  16. 16.
    Gómez-San E, Guerrero A, Morales A, Pérez-Gorricho B (1986) Sacroileitis infecciosa. Med Clín 86:37–39Google Scholar
  17. 17.
    Hizel K, Guzel O, Dizbay M, Karakus R, Senol E, Arman D et al (2007) Age and duration of disease as factors affecting clinical findings and sacroiliitis in brucellosis. Infection 35:434–437CrossRefPubMedGoogle Scholar
  18. 18.
    Martínez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason EO Jr, Kaplan SL (2004) Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J 23(8):701–706CrossRefPubMedGoogle Scholar
  19. 19.
    Manzur A, Dominguez AM, Pujol M, González MP, Limón E, Hornero A, Martín R, Gudiol F, Ariza J (2008) Community-acquired methicillin-resistant staphilococcus aureus infections: an emerging threat in Spain. Clin Microbiol Infect 14:377–380CrossRefPubMedGoogle Scholar
  20. 20.
    Vander Have KL, Karmazyn B, Verma M, Caird MS, Hensinger RN, Farley FA, Lubicky JP (2009) Community-associated methicillin-resistant Staphylococcus aureus in acute musculoskeletal infection in children: a game changer. J Pediatr Orthop 29(8):927–931PubMedGoogle Scholar
  21. 21.
    Blum U, Buitrago-Tellez C, Mudinger A, Krause T, Laubenberger J, Vaith P, Peter HH, Langer M (1996) Magnetic resonance imaging (MRI) for detection of active sacroiliitis. A prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol 23(12):2107–2115PubMedGoogle Scholar
  22. 22.
    Connolly LP, Connolly SA, Drubach LA, Jaramillo D, Treves ST (2002) Acute hematogenous osteomyelitis of children: assessment of skeletal scintigraphy-based diagnosis in the Era of MRI. J Nucl Med 43(10):1310–1316PubMedGoogle Scholar
  23. 23.
    Le Saux N, Howard A, Barrowman NJ, Gaboury I, Sampson M, Moher D (2002) Shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis: a systematic review. BMC Infect Dis 2(16):1–9Google Scholar
  24. 24.
    Peltola H, Pääkkönen M, Kallio P, Kallio MJ (2009) Prospective, randomized trial of 10 days versus 30 days of antimicrobial treatment, including a short-term course of parenteral therapy, for childhood septic arthritis. Clin Infect Dis 48(9):1201–1210CrossRefPubMedGoogle Scholar
  25. 25.
    Kumar J, Ramachandran M, Little D, Zenios M (2010) Pelvic osteomyelitis in children. J Pediatr Orthop B 19:38–41PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Agueda Molinos Quintana
    • 1
  • Beatriz Morillo Gutiérrez
    • 1
  • M. Soledad Camacho Lovillo
    • 1
  • Olaf Neth
    • 1
    Email author
  • Ignacio Obando Santaella
    • 1
  1. 1.Department of Pediatric Infectious Diseases and Immunodeficiencies, Pediatric Research Group, PAI CTS-186University Hospital Virgen del RocíoSevilleSpain

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