Septic sacroiliitis with iliacus muscle abscess - A case report

Abstract

We present a case of a 26-year-old previously healthy young male with radiologically confirmed septic sacroiliitis and left iliacus muscle abscess during staphylococcal sepsis. The disease onset was sudden with high fever, chills and shivering accompanied by pain in the lower back and left hip. Standard laboratory analysis on admission revealed moderately increased sedimentation rate 26 mm/1h (increasing up to 60 mm/1 h on the third day), elevated CRP 123 mg/L, mild leukocytosis 11.1 with neutrophilia 78 % in differential blood count, mild hypoproteinemia 61 g/L and hypoalbuminemia 33 g/L with elevated alpha-1 (6.8 %) and alpha-2 (11.2 %) globulins in protein electrophoresis and fibrinogen 7.74 g/L. Other routine laboratory tests were normal. The isolation of Staphylococcus aureus from blood culture has enabled early etiological therapy. Skeletal scintigraphy and targeted radiographic imaging as well as computed tomography of the sacroiliac joint revealed the location of the inflammatory process. Administered antimicrobial therapy (vancomycin and ciprofloxacin parenterally for 2 weeks, cefazolin parenterally for 4 weeks, cephalexin perorally for 3 weeks) resulted in full clinical recovery with almost complete regression of the changes observed on radiological images taken during follow-up visit. Septic sacroiliitis is an extremely rare complication during staphylococcal bacteremia and for this reason we decided to report a case that was successfully treated with conservative therapy.