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Postpartum septic sacroiliitis misdiagnosed as sciatic neuropathy
Xiao-Qing Liu1, Fang-Cai Li, Jia-Wei Wang
1Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, People's Republic of China.
The American Journal of the Medical Sciences
|January 22, 2010
Summary
Early diagnosis of septic sacroiliitis is challenging, particularly in postpartum women. This case highlights that nerve irritation, mimicking sciatic neuropathy, can be an early sign of septic sacroiliitis.
Area of Science:
- Infectious Diseases
- Neurology
- Radiology
Background:
- Septic sacroiliitis diagnosis is often delayed due to nonspecific symptoms.
- Pregnancy and postpartum periods present unique diagnostic challenges for sacroiliac joint infections.
Observation:
- A postpartum patient presented with buttock pain and sensory deficit, initially diagnosed as sciatic neuropathy.
- Initial imaging (X-ray, CT) did not reveal sacroiliac joint abnormalities.
- Electromyography indicated neurogenic abnormalities in the affected lower limb.
Findings:
- Bone scintigraphy revealed increased Tc-99m methylene diphosphonate uptake in the left sacroiliac joint.
- Magnetic resonance imaging (MRI) showed signal abnormalities in the left sacroiliac joint.
- Diagnosis of septic sacroiliitis was confirmed by positive response to antibiotic therapy.
Implications:
- Nerve irritation and injury may be presenting symptoms of septic sacroiliitis.
- This case underscores the importance of considering septic sacroiliitis in postpartum patients with unexplained limb symptoms.
- Advanced imaging and prompt antibiotic treatment are crucial for effective management.