Location
Philadelphia, PA
Start Date
30-4-2025 1:00 PM
End Date
30-4-2025 4:00 PM
Description
Background: Septic arthritis is an infection of a joint typically by bacteria. It classically presents as a warm, erythematous, tender and edematous joint with limited active and passive range of motion. Non-gonococcal septic arthritis most commonly occurs in knee and hip joints, followed by shoulders, wrists, and ankles. Atypical joint infections, such as the sacroiliac joint are extremely uncommon. In this report, we demonstrate a case of a young patient, with no predisposing factors with a unique presentation of sacroiliac septic arthritis.
Case description: 29-year-old female with no pertinent past medical history presented to Roxborough Memorial Hospital with severe 10/10 pain in her left buttock and lower back with intermittent numbness and tingling into the left lower extremity. She had originally presented the day before to the ED and was discharged with pain medication and a muscle relaxer. When she returned home, the pain was so severe, she returned to the hospital. Prior to her original arrival, she was immobilized for 12 hours during a long car ride, after which was when her pain began. In the ED, she was hypotensive, WBC 15.4, lactic acid 2.5. Blood cultures were drawn, and she was started on IV fluids, Unasyn and ceftriaxone for suspected sepsis with an unknown cause. Infectious disease recommended obtaining an MRI lumbosacral spine which showed mild symmetric iliopsoas edema and enhancement. Blood cultures were positive for MSSA bacteremia. Due to persistent pain, she had a repeat MRI 5 days later, showing interval increase in mild edema and enhancement within the left iliac bone and left sacrum adjacent to the sacroiliac joint. There was no evidence of a drainable collection, confirmed by interventional radiology. She was evaluated by orthopedic surgery who confirmed that no surgical intervention was required. She was also evaluated by the osteopathic manipulative medicine (OMM) service for OMT for her low back and sacral pain. She had a PICC line placed for extensive antibiotic therapy at home. She had a repeat MRI 9 days post discharge which showed left-sided sacroiliac joint edema and enhancement, concerning for septic arthritis. At this time, she was unable to walk and was utilizing a wheelchair while out of the house. She was evaluated at the OMM Clinic 1 month later, with significant improvement of her symptoms within the last week before her appointment. She reports that 9 days before, she was switched to daptomycin and noticed significant improvement in her functional ability. She remained using her crutches and began physical therapy 1 week after this appointment. The etiology of her infection remained unclear.
Discussion: This patient’s case describes an unusual presentation of septic arthritis in the sacroiliac joint. This is a rare condition, affecting only 1-2% of individuals with septic arthritis, typically seen in patients who use intravenous drugs, of which our patient had no known history. This patient’s diagnosis remained insidious throughout her early hospitalization, and the etiology remained unclear, as she had no clear risk factors or known causes for the infection.
Embargo Period
5-29-2025
Included in
Sacroiliac Joint Septic Arthritis: A Case Report
Philadelphia, PA
Background: Septic arthritis is an infection of a joint typically by bacteria. It classically presents as a warm, erythematous, tender and edematous joint with limited active and passive range of motion. Non-gonococcal septic arthritis most commonly occurs in knee and hip joints, followed by shoulders, wrists, and ankles. Atypical joint infections, such as the sacroiliac joint are extremely uncommon. In this report, we demonstrate a case of a young patient, with no predisposing factors with a unique presentation of sacroiliac septic arthritis.
Case description: 29-year-old female with no pertinent past medical history presented to Roxborough Memorial Hospital with severe 10/10 pain in her left buttock and lower back with intermittent numbness and tingling into the left lower extremity. She had originally presented the day before to the ED and was discharged with pain medication and a muscle relaxer. When she returned home, the pain was so severe, she returned to the hospital. Prior to her original arrival, she was immobilized for 12 hours during a long car ride, after which was when her pain began. In the ED, she was hypotensive, WBC 15.4, lactic acid 2.5. Blood cultures were drawn, and she was started on IV fluids, Unasyn and ceftriaxone for suspected sepsis with an unknown cause. Infectious disease recommended obtaining an MRI lumbosacral spine which showed mild symmetric iliopsoas edema and enhancement. Blood cultures were positive for MSSA bacteremia. Due to persistent pain, she had a repeat MRI 5 days later, showing interval increase in mild edema and enhancement within the left iliac bone and left sacrum adjacent to the sacroiliac joint. There was no evidence of a drainable collection, confirmed by interventional radiology. She was evaluated by orthopedic surgery who confirmed that no surgical intervention was required. She was also evaluated by the osteopathic manipulative medicine (OMM) service for OMT for her low back and sacral pain. She had a PICC line placed for extensive antibiotic therapy at home. She had a repeat MRI 9 days post discharge which showed left-sided sacroiliac joint edema and enhancement, concerning for septic arthritis. At this time, she was unable to walk and was utilizing a wheelchair while out of the house. She was evaluated at the OMM Clinic 1 month later, with significant improvement of her symptoms within the last week before her appointment. She reports that 9 days before, she was switched to daptomycin and noticed significant improvement in her functional ability. She remained using her crutches and began physical therapy 1 week after this appointment. The etiology of her infection remained unclear.
Discussion: This patient’s case describes an unusual presentation of septic arthritis in the sacroiliac joint. This is a rare condition, affecting only 1-2% of individuals with septic arthritis, typically seen in patients who use intravenous drugs, of which our patient had no known history. This patient’s diagnosis remained insidious throughout her early hospitalization, and the etiology remained unclear, as she had no clear risk factors or known causes for the infection.