[Infectious sacroiliitis during pregnancy and the postpartum period: A case report and literature review]

Infectious sacroiliitis is a rare condition, accounting for 1-2% of septic arthritis cases. Its risk factors remain poorly defined, although several studies suggest an association with pregnancy and the postpartum period.

Based on a case of postpartum infectious sacroiliitis, we conducted a literature review to describe the clinical, microbiological, and therapeutic features of this entity.

A systematic search, without date or language restrictions, identified 36 articles published between 1933 and 2024. The median age of patients was 26 years [24-32], and the median time to diagnosis was 12,5 days (extremes [3-21] days). Pain was constant, most located in the buttock (63,6%) or lower limb (42,4%) and was associated with fever (≥38.0°C) in over 75% of cases. When performed, MRI was invariably abnormal. Staphylococcus aureus was the most frequently isolated pathogen (33%), whereas no microbiological documentation was obtained in nearly one-quarter of cases. Beta-lactams were the most used antibiotics (82,3%), and surgical intervention was required in 25% of patients.

Diagnosis, often delayed, should be considered in any patient presenting with febrile lumbar or buttock pain during pregnancy or postpartum. The absence of fever does not rule out the diagnosis. MRI is the imaging modality of choice. Treatment relies on antibiotic therapy, sometimes combined with surgery, with generally favourable outcomes.