Serratia Sacroiliitis Secondary to Intravenous Drug Use: A Case Report

Serratia spp. are ubiquitous, opportunistic, and infectious organisms that have historically been known to infect the upper respiratory, urinary, and circulatory systems. This manuscript presents the case of a 35-year-old White female with a past medical history of polysubstance abuse, intravenous drug use (IVDU), and poor dentition who was admitted to a community hospital with complaints of lower back pain for 10 days following the recent completion of treatment for a suspected epidural abscess. Per her report, her last IVDU with fentanyl was 11 days prior, and she admitted to using various sources of water to inject her drugs. Magnetic resonance imaging with contrast was significant for possible infectious sacroiliitis, and blood cultures grew Serratia marcescens. Due to this patient's extensive IVDU history, in-patient ceftriaxone was chosen over discharging the patient with a peripherally inserted central catheter line. Serratia spp.bacteremia with concomitant septic sacroiliitis in the setting of IVDU is an extremely rare presentation. Due to the nonspecific presentation of sacroiliitis, multidrug resistance profile of Serratia spp., and high mortality rate associated with S. marcescens sepsis, early detection and diagnosis is paramount in similar patients with extensive risk factors.