Perinatal sacroiliitis diagnostic challenges

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Musculoskeletal Disorders

Background:

• Lumbo-pelvic pain is frequent in pregnancy and postpartum.
• Perinatal pyogenic sacroiliitis is rare and can mimic other conditions.
• Distinguishing it from reactive sacroiliitis is challenging due to unclear symptoms and non-definitive tests.

Observation:

• A 34-year-old primigravida presented with severe, worsening low back pain radiating to the right gluteal region and posterior thigh.
• She had a fever, but pelvic and lumbo-sacral X-rays showed no significant findings besides slight symphysis pubis widening.
• Initial clinical impression was right lumbo-pelvic pain, leading to admission for pain management.

Findings:

• Antibiotic therapy, initially for a presumed urinary tract infection, resulted in significant symptom improvement.
• This recovery supported the diagnosis of pyogenic sacroiliitis, even without definitive joint aspirate cultures.
• The case highlights the diagnostic challenges of pyogenic sacroiliitis in the perinatal period.

Implications:

• This case underscores the importance of considering pyogenic sacroiliitis in pregnant or postpartum women with severe, unexplained lumbo-pelvic pain and fever.
• Prompt antibiotic treatment can be effective, even with ambiguous diagnostic findings.
• Further research into differentiating pyogenic from reactive sacroiliitis in this population is warranted.