Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology

Background:

• Osteoarticular tuberculosis is a significant health issue in developing nations, frequently impacting bones and joints.
• Sacroiliac joint tuberculosis is a notable manifestation, with increasing incidence and potential for neurological and surgical complications if not diagnosed early.
• This report details a unique case of tuberculous arthritis in the sacroiliac joint, originating after a penicillin injection.

Purpose of the Study:

• To present a rare case of sacroiliac joint tuberculosis following penicillin injection.
• To emphasize the importance of early diagnosis and appropriate treatment for osteoarticular tuberculosis.
• To illustrate the long-term imaging outcomes of tuberculous sacroiliitis.

Main Methods:

• A case study of a 32-year-old male patient presenting with chronic buttock symptoms after penicillin injection.
• Diagnostic procedures included physical examination, laboratory tests, and microbiological culture for Mycobacterium tuberculosis.
• Treatment involved a standard 4-drug anti-tuberculosis therapy (rifampin, isoniazid, ethambutol, pyrazinamide) for 18-24 months, supplemented with vitamin B6 and pantoprazole.

Main Results:

• The patient presented with a 17-year history of buttock symptoms initiated by penicillin injection, including an draining sinus.
• Mycobacterium tuberculosis was identified via culture, confirming tuberculous arthritis of the right sacroiliac joint.
• After 2 years of treatment and follow-up, MRI revealed reduced inflammation in the sacroiliac joint, although the overall size of the affected area remained unchanged.

Conclusions:

• Tuberculosis of the sacroiliac joint, though rare, can occur following non-standard medical interventions like penicillin injections.
• A prolonged course of multi-drug anti-tuberculosis therapy is effective in managing sacroiliac joint tuberculosis.
• Long-term follow-up with MRI demonstrates resolution of inflammatory changes in tuberculous sacroiliitis post-treatment.