Pyogenic Sacroiliitis in a 13-Month-Old Child: A Case Report and Literature Review
Julien Leroux1, Isabelle Bernardini, Lucie Grynberg
1From the Clinique Chirurgicale Infantile, CHU de Rouen, Hôpital Charles Nicolle, Rouen cedex (JL, IB, LG, MR-P); Université de Rouen, Mont-Saint-Aignan (JL, IB, LG, CG, MR-P, MOS); Département d'Anesthésie et Réanimation, CHU de Rouen, Hôpital Charles Nicolle (CG); Service de Radiologie, CHU de Rouen, Hôpital Charles Nicolle (PM); Service de Chirurgie Orthopédique et Traumatologique, CHU de Rouen, Hôpital Charles Nicolle, Rouen cedex (MOS); Service de Chirurgie et d'Orthopédie de l'Enfant, CHRU de Lille, Lille cedex (EN); Université Lille 2 Droit et Santé, Lille (EN); Service de Chirurgie de l'Enfant, CHU Amiens-Picardie site sud, Amiens cedex 1 (FD, RG); Université de Picardie, Amiens (FD, RG); Service de Chirurgie Infantile, CHU de Bordeaux, Hôpital des Enfants, place Amélie Raba-Léon Bordeaux (AA); Université de Bordeaux, Collège Sciences de la Santé, Bordeaux cedex (AA); Service d'Orthopédie Pédiatrique, Assistance Publique des Hôpitaux de Paris, Hôpital Robert Debré, Paris (BI); and Université Paris Diderot Paris 7, Paris, France (BI).
Insights
Pyogenic sacroiliitis is rare in young children, often presenting with misleading symptoms. Early diagnosis using bone scintigraphy and MRI, followed by prompt antibiotic treatment, ensures rapid recovery and healing.
Area of Science:
- Pediatric infectious diseases
- Pediatric rheumatology
- Pediatric orthopedics
Background:
- Pyogenic sacroiliitis is an uncommon infection in very young children, posing diagnostic challenges due to subtle clinical signs.
- Limping and decreased weight-bearing are common presenting symptoms, potentially delaying accurate diagnosis.
Observation:
- A 13-month-old child presented with decreased weight-bearing without fever or trauma, exhibiting an inflammatory syndrome.
- Clinical examination was inconclusive, but bone scintigraphy and MRI confirmed pyogenic sacroiliitis.
- Joint fluid aspiration identified the pathogen, guiding empiric biantibiotic therapy.
Findings:
- The child experienced rapid symptom resolution and full weight-bearing recovery within days of initiating intravenous antibiotic therapy.
- Inflammatory markers normalized quickly, allowing a switch to oral antibiotics and subsequent discontinuation.
Implications:
- This case underscores the importance of considering pyogenic sacroiliitis in young children despite its rarity.
- Advanced imaging like bone scintigraphy and MRI are crucial for diagnosing osteoarticular infections in this age group.
- Prompt diagnosis and appropriate antibiotic treatment lead to favorable outcomes in pediatric pyogenic sacroiliitis.
Abstract:
Pyogenic sacroiliitis is exceptional in very young children. Diagnosis is difficult because clinical examination is misleading. FABER test is rarely helpful in very young children. Inflammatory syndrome is frequent. Bone scintigraphy and MRI are very sensitive for the diagnosis. Joint fluid aspiration and blood cultures are useful to identify the pathogen. Appropriate antibiotic therapy provides rapid regression of symptoms and healing. We report the case of pyogenic sacroiliitis in a 13-month-old child.Clinical, biological, and imaging data of this case were reviewed and reported retrospectively.A 13-month-old girl consulted for decreased weight bearing without fever or trauma. Clinical examination was not helpful. There was an inflammatory syndrome. Bone scintigraphy found a sacroiliitis, confirmed on MRI. Aspiration of the sacroiliac joint was performed. Empiric intravenous biantibiotic therapy was started. Patient rapidly recovered full weight bearing. On the 5th day, clinical examination and biological analysis returned to normal. Intravenous antibiotic therapy was switched for oral. One month later, clinical examination and biological analysis were normal and antibiotic therapy was stopped.Hematogenous osteoarticular infections are common in children but pyogenic sacroiliitis is rare and mainly affects older children. Diagnosis can be difficult because clinical examination is poor. Moreover, limping and decreased weight bearing are very common reasons for consultation. This may delay the diagnosis or refer misdiagnosis. Bone scintigraphy is useful to locate a bone or joint disease responsible for limping. In this observation, bone scintigraphy located the infection at the sacroiliac joint. Given the young age, MRI was performed to confirm the diagnosis. Despite the very young age of the patient, symptoms rapidly disappeared with appropriate antibiotic therapy.We report the case of pyogenic sacroiliitis in a 13-month-old child. It reminds the risk of misdiagnosing pyogenic sacroiliitis in children because it is exceptional and clinical examination is rarely helpful. It also highlights the usefulness of bone scintigraphy and MRI in osteoarticular infections in children.
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