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Sacroiliac joint tuberculosis

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Abstract

Infections of the sacroiliac joint are uncommon and the diagnosis is usually delayed. In a retrospective study, 17 patients who had been treated for tuberculosis sacroiliitis between 1994 and 2004 were reviewed. Two patients were excluded due to a short follow-up (less than 2 years). Low back pain and difficulty in walking were the most common presenting features. Two patients presented with a buttock abscess and spondylitis of the lumbar spine was noted in two patients. The Gaenslen’s and FABER (flexion, abduction and external rotation) tests were positive in all patients. Radiological changes included loss of cortical margins with erosion of the joints. An open biopsy and curettage was performed in all patients; histology revealed chronic infection and acid-fast bacilli were isolated in nine patients. Antituberculous (TB) medication was administered for 18 months and the follow-up ranged from 3 to 10 years (mean: 5 years). The sacroiliac joint fused spontaneously within 2 years. Although all patients had mild discomfort in the lower back following treatment they had no difficulty in walking. Sacroiliac joint infection must be included in the differential diagnosis of lower back pain and meticulous history and clinical evaluation of the joint are essential.

Résumé

L’infection des sacro-iliaques est rare et le diagnostic est souvent retardé. Dans une revue rétrospective 17 patients étaient traités pour une tuberculose sacro-iliaque entre 1994 et 2004. Deux patients étaient exclus à cause d’un suivi de moins de 2 ans. Des lombalgies et des difficultés de marche étaient les signes les plus fréquents. Deux patients présentaient un abcés de la fesse et deux autres une spondylite lombaire. Les test de Faber et de Gaenslen étaient positif chez tous les patients. Les signes radiologiques comportaient des érosions articulaires et des lyses corticales. Un curetage- biopsie était fait chez tous les patients et un bacille acido-résistant était isolé chez 9 patients. Un traitement anti-tuberculeux était administré pour 18 mois et le suivi était de 3 à 10 ans (en moyenne 5 ans). L’articulation sacro-iliaque se fusionnait dans les 2 ans. Bien que tous les patients gardaient un certain disconfort lombaire, ils n’avaient pas de difficulté de marche. L’infection sacro-iliaque doit faire partie des diagnostics différentiels des lombalgies et une évaluation méticuleuse de l’histoire et de la clinique est essentielle.

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Authors and Affiliations

  1. Spinal Unit, King George V Hospital, University of Kwa-Zulu Natal, Durban, South Africa

    R. J. S. Ramlakan

  2. Department of Orthopaedics, University of Kwa-Zulu Natal, Durban, South Africa

    S. Govender

  3. Nelson Mandela School of Medicine, 719 Umbilo Rd, Room 403, 4th Floor Congella, Durban, 4001, South Africa

    R. J. S. Ramlakan

Authors
  1. R. J. S. Ramlakan
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  2. S. Govender
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Correspondence to R. J. S. Ramlakan.

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Ramlakan, R.J.S., Govender, S. Sacroiliac joint tuberculosis. International Orthopaedics (SICO 31, 121–124 (2007). https://doi.org/10.1007/s00264-006-0132-9

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  • DOI: https://doi.org/10.1007/s00264-006-0132-9

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