Sacroiliac joint abscess and osteomyelitis associated with wet cupping therapy: a case report

Wet cupping therapy (Hijama) is a widely practiced procedure in traditional medicine. When performed under non-sterile conditions, it can lead to severe infections. In this report, we present a case of sacroiliac abscess and osteomyelitis that developed following cupping therapy.

A 35-year-old male patient with no known systemic disease presented with a two-month history of lower back and right leg pain. Magnetic Resonance Imaging (MRI) revealed an abscess extending into the iliopsoas muscle at the right sacroiliac joint and osteomyelitis of the iliac bone. Upon further questioning, it was revealed that wet cupping therapy had been applied to the affected area. Methicillin-sensitive Staphylococcus epidermidis was isolated from two separate blood cultures. The patient was managed with sequential therapy consisting of intravenous teicoplanin followed by oral moxifloxacin. At the end of 6 months of treatment, full clinical and radiological recovery was achieved. No recurrence was observed during 15 months of follow-up.

When performed under non-sterile conditions, wet cupping therapy may result in serious complications such as deep tissue infections. It is important to consider rare infections like sacroiliac abscess in the differential diagnosis of patients presenting with similar symptoms.