Sacroiliitis associated with pyelonephritis in pregnancy

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Radiology

Background:

• Sacroiliitis is an uncommon cause of back pain during pregnancy.
• Pregnancy and associated infections are risk factors for sacroiliitis.
• Consider sacroiliitis in pregnant patients presenting with sacroiliac pain.

Observation:

• A 17-year-old pregnant patient (24 weeks' gestation) with a history of drug use presented with severe back and buttock pain.
• Initial treatment for bacteriuria and pyuria with cefazolin was ineffective.
• Blood cultures identified Staphylococcus aureus and Escherichia coli, despite which pain persisted.

Findings:

• Radiographic studies confirmed sacroiliitis.
• Broadened antibiotic therapy led to a complete cure.
• Magnetic resonance imaging (MRI) or computed axial tomography (CT) can aid diagnosis.

Implications:

• Early consideration of sacroiliitis in pregnant patients with back pain is essential.
• Diagnostic imaging, particularly MRI, is valuable for suspected sacroiliitis.
• Prolonged, targeted antibiotic therapy (3-6 weeks) is necessary for successful treatment.