Pyogenic sacroiliitis in children: don't forget the very young
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Eran Lavi1, Alex Gileles-Hillel1, Natalia Simanovsky2
1Department of Pediatrics, Mount Scopus Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel.
Insights
Pyogenic sacroiliitis (PS) in infants presents a distinct, milder condition compared to older children. Early recognition of symptoms like fever and irritability is crucial for prompt diagnosis and recovery in infants with this rare infection.
Area of Science:
- Pediatric infectious diseases
- Pediatric rheumatology
- Pediatric orthopedics
Background:
- Pyogenic sacroiliitis (PS) is a rare pediatric condition, with fewer than 100 cases documented.
- Classical PS typically affects adolescents and is often caused by Staphylococcus aureus, presenting a complicated clinical course.
- Diagnosis can be challenging due to the rarity and difficulty in assessing the sacroiliac joint.
Purpose of the Study:
- To characterize pediatric pyogenic sacroiliitis by analyzing cases at an academic tertiary center.
- To identify distinct clinical presentations and outcomes of PS in different pediatric age groups.
- To highlight an under-recognized entity of PS in infants.
Main Methods:
- Retrospective data analysis of hospitalized children aged 16 years or younger diagnosed with PS between 2000 and 2017.
- Evaluation of 18 pediatric PS cases out of 894 osteoarticular infections.
- Categorization into two groups: infants (≤1.1 years) and older children (>11 years).
Main Results:
- Infants (n=13, 72.2%) presented with an indolent course, faster recovery, and unidentified bacterial sources.
- Older children (n=5, 27.8%) experienced a more complicated course with a higher rate of identified bacterial infections.
- Infants with PS did not develop invasive complications, unlike the classical presentation.
Conclusions:
- Pyogenic sacroiliitis in infants represents a distinct clinical entity with a milder course and rapid recovery.
- Key indicators for infant PS include fever, irritability, decreased pelvic range of motion, and pain during diapering.
- Prompt clinical suspicion and diagnosis in infants can lead to favorable outcomes without invasive complications.
Abstract:
Pyogenic sacroiliitis (PS) is rare with less than 100 pediatric cases reported in the medical literature. To better characterize PS in the pediatric population, we investigated a series of children presenting with PS. Retrospective data analysis was done at an academic tertiary center between the years of 2000 and 2017. All hospitalized children ≤ 16 years of age with PS were evaluated. Of the 894 children hospitalized with osteoarticular infections, 18 were diagnosed with PS (2%) and are included in the review. Two clinically distinct groups were identified. PS in infants (n = 13, 72.2%, mean age 1.1 years) had an indolent course and a faster recovery without any bacterial source identified. In contrast, the group of older children (n = 5, 27.8%, mean age 11.6 years) had a more complicated course and a higher rate of identified bacterial infections.Conclusion: We describe an under-recognized entity of PS in infants with a mild clinical course and fast recovery that differ from the "classical" septic sacroiliitis. Infants with PS did not suffer from invasive complications, and pathogen characteristics of older children were not identified. Infants with fever, irritability, decreased range of motion in the pelvic area, and pain during diapering should alert the clinician to this diagnosis. What is Known: • Pediatric pyogenic sacroiliitis is an extremely rare condition usually caused by Staphylococcus aureus with highest incidence in adolescents. • The diagnosis of PS is challenging due to its rarity and difficulty in assessing the sacroiliac joint. What is New: • We describe an under-recognized entity of PS in infants with a mild clinical course, without invasive complications and with fast recovery that differ from "classical" septic sacroiliitis. • Infants with fever, irritability, decreased range of motion in the pelvic area and pain during diapering should raise clinical suspicion of this diagnosis.