Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report
  • Mohammad Darvishi
    Infectious Diseases and Tropical Medicine Research Center, Dept of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
  • Sana Rashidi
    Faculty of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
  • Setayesh Abazari
    Faculty of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran

Keywords

Tuberculous sacroiliitis, tuberculous arthritis, sacroiliac joint, case report

Abstract

Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection.
The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal.
During hospitalization, initial antibiotic therapy was prescribed. After Mycobacterium tuberculosis was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18–24 months, in addition to daily vitamin B6 and pantoprazole.

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References


  1. Pigrau-Serrallach C, Rodriguez-Pardo D. Bone and joint tuberculosis. Eur Spine J 2013;22 Suppl 4:556–566.

  2. Slobodin G, Rimar D, Boulman N, Kaly L, Rozenbaum M, Rosner I, et al. Acute sacroiliitis. Clin Rheumatol 2016;35(4):851–856.

  3. Benchakroun M, El Bardouni A, Zaddoug O, Kharmaz M, Lamrani MO, El Yaacoubi M, et al. Tuberculous sacroiliitis. Four cases. Joint Bone Spine 2004;71(2):150–153.

  4. Nicholson RA. Twenty years of bone and joint tuberculosis in Bradford. A comparison of the disease in the indigenous and Asian populations. J Bone Joint Surg Br 1974;56(4):760–765.

  5. Osman AA, Govender S. Septic sacroiliitis. Clin Ortho 1995;313:214–219.

  6. Punia VPS, Kumar S. Atypical manifestation of sacral tuberculosis as cauda-conus syndrome. JIACM 2008;9:57–60.

  7. Ramlakan RJS, Govender S. Sacroiliac joint tuberculosis. Int Orth 2007;31(1):121–124.

  8. Kim NH, Lee HM, Yoo JD, Suh JS. Sacroiliac joint tuberculosis – classification and treatment. Clin Orthop Relat Res 1999;358:215–222.

  9. Davies PD, Humphries MJ, Byfield SP, Nunn AJ, Darbyshire JH, Citron KM, et al. Bone and joint tuberculosis. A survey of notifications in England and Wales. J Bone Joint Surg Br 1984;66:326–330.

  10. Garg IK, Kumar L, Gaurav J. Case report. Tuberculosis of sacroiliac joint – a rare case. J Adv Res Biol Sci 2012;4(1):85–87.

  11. Gupta R, Beimenstoch H, Morano P, Gupta A. Tuberculosis of sacroiliac joint – an unusual presentation. J Natl Med Assoc 2005;97(8):1174–1176.

  12. Chen WS. Chronic sciatica caused by tuberculosis sacroiliitis – a case report. Spine 1995;20:1194–1196.

  13. Papagelopoulos PJ, Padapoulos EC, Mavrogenis AF, Themistocleous GS, Korres DS, Soucacos PN. Tuberculous sacroiliitis. A case report and review of the literature. Eur Spine J 2005;14(3):683–688.

  14. Gelal F, Sabah D, Dogan R, Avci A. Multifocal skeletal tuberculosis involving the lumbar spine and a sacroiliac joint: MR imaging findings. Diagn Inter Radiol 2006;12(3):139–141.

  15. Nakase M. Tuberculosis of the sacroiliac joint: a case report. Jpn J Joint Dis 2009;28(2):261–264.

  16. Attarian DE. Septic sacroiliitis: the overlooked diagnosis. J South Orthop Assoc 2001;10(1):57–60.

  17. Coy JT, Wolf CR, Brower TD, Winter WG. Pyogenic arthritis of the sacro-iliac joint. Long-term follow-up. J Bone Joint Surg Am 1976;58(6):845–849.

  18. Dunn EJ, Bryan DM, Nugent JT, Robinson RA. Pyogenic infections of the sacroiliac joint. Clin Orthop 1976;118:113–118.

  19. Goldberg J, Kovarsky J. Tuberculous sacroiliitis. South Med J 1983;76(9):1175–1176.

  20. Gordan G, Kabins SA. Pyogenic sacroiliitis. Am J Med 1980;69:50–56.

  21. Soholt ST. Tuberculosis of the sacroiliac joint. J Bone Joint Surg Am 1951;33(1):119–129.

  22. Bouajina E, Harzallah L, Hachfi W, Slama KB, Rammeh N, Ghannouchi M, et al. Tuberculous sacro-iliitis: a series of twenty-two cases. Rev Med Interne 2005; 26:690–694.

  23. Bernard TN Jr, Cassidy JD. The sacroiliac joint syndrome. Pathophysiology, diagnosis, and management. In: Frymoyer JW, editor. The adult spine: principles and practice. Philadelphia: Lippincott-Raven; 1997, p. 2343–2366.

  24. Bernard TN Jr, Kirkland-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res 1987;217:266–280.

  25. Bonica JJ. Anatomic and physiologic basis of nociception and pain. Philadelphia: Lea & Febinger; 1990, p. 18–27.

  26. Brasseur P, Koral E, Sukkarieh F, Vanhaeverbeek M, Bissen L. Tuberculous sacroiliitis: report of a case. Rev Med Brux 2004;25(2):99–102.

  27. Laeslett M, Williams M. The reliability of selected pain provocation tests for sacroiliac joint pathology. Spine 1994;19(11):1243–1248.

  28. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis 2009;49(9):1350–1357.

  29. Prakash J. Sacroiliac tuberculosis – a neglected differential in refractory low back pain – our series of 35 patients. J Clin Orthop Trauma 2014;5(3):146–153.

  30. Gao F, Kong XH, Tong XY, Xie DH, Li YG, Guo JJ, et al. Tuberculous sacroiliitis: a study of the diagnosis, therapy and medium-term results of 15 cases. J Int Med Res 2011;39(1):321–335.

  31. Patwardhan SA, Joshi S. Laboratory diagnosis of spinal tuberculosis: past and present. ArgoSpine News J 2011;23(3):120–124.

  32. Pouchot J, Vinceneux P, Barge J, Boussougant Y, Grossin M, Pierre J, et al. Tuberculosis of the sacroiliac joint: clinical features, outcome and evaluation of closed needle biopsy in 11 consecutive cases. Am J Med 1988;84:622–628.

  33. Richter R, Nubling W, Kobler G, Iljinski A. Tuberculosis of the iliosacral joints. Treatment, results, prognosis and differential diagnosis. Z Orthop Ihre Grenzgeb 1983;121(5):564–570.

  34. Patankar T, Krishnan A, Patkar D, Kale H, Prasad S, Shah J, et al. Imaging in isolated sacral tuberculosis: a review of 15 cases. Skeletal Radiol 2000;29:392–396.

  35. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2002;51:101.

  36. Davidson PT, Horowitz I. Skeletal tuberculosis. A review with patient presentations and discussion. Am J Med 1970;48(1):77–84.

  37. Kele? I, Aydin G, Kitay OL, Orkun S. Tuberculous sacroiliitis: a case report. Rheumatol Int 2004;24(5):312–314.

  38. Ludmerer KM, Kissane JM. Clinicopathologic conference. Severe right hip pain in a 73-year-old woman. Am J Med1986;81(1):117–124.

  39. Moujtahid M, Essadki B, Lamine A, Fikry T, Bennouna D, Dkhissi M, et al. Tuberculous osteitis in limbs. Twenty five case-reports. Rev Rhum Engl Ed 1996;63(5):344–348.

  40. Resnick D, Niwayama G. Osteomyelitis, septic arthritis, and soft tissue infection: organisms. In: Resnick D, editor. Diagnosis of bone and joint disorders. Philadelphia: Saunders; 1995, p. 2461–2485.

  41. Burrill J, Williams C, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics 2007;27:1255–1273.

  42. Dunn EJ, Bryan DM, Nugent JT, Robinson RA. Pyogenic infections of the sacroiliac joint. Clin Orthop 1976;118:113–118.

  43. Feldmann JL, Menkes CJ, Weill B, Delrieu F, Delbarre F. Infectious sacroiliitis. Multicenter study of 214 cases. Rev Rhum Mal Osteoartic 1981;48(1):83–91.

  44. Vaiopoulos G, Sfikakis PP, Velikas E, Kittas C, Kaklamanis P. Tuberculosis of the sacroiliac joint. Eur Spine J 1997;6(5):330–331.

  45. Wellons JC, Zomorodi AR, Villaviciencio AT, Woods CW, Lawson WT, Eastwood JD. Sacral tuberculosis: a case report and review of the literature. Surg Neurol 2004;61:136–141.

  46. Watts HG, Lifeso RM. Tuberculosis of bones and joints. J Bone Joint Surg Am 1996;78(2):288–298.

  47. Seddon HJ, Strange FG. Sacroiliac tuberculosis. Br J Surg 1940;28:193–221.

  48. Vaiopoulos G, Sfikakis PP, Velikas E, Kittas C, Kaklamanis P. Tuberculosis of the sacroiliac joint. Eur Spine J 1997;6(5):330–331.

  49. Kim NH, Lee HM, Suh JS. Magnetic resonance imaging for the diagnosis of tuberculous spondylitis. Spine 1994;19(21):2451–2455.

  50. Hong SH, Kim SM, Ahn JM, Chung HW, Shin MJ, Kang HS. Tuberculous versus pyogenic arthritis: MR imaging evaluation. Radiology 2001;218(3):848–853.

  51. Lindahl S, Nyman RS, Brismar J, Hugosson C, Lundstedt C. Imaging of tuberculosis. IV. Spinal manifestations in 63 patients. Acta Radiol 1996;37:506–511.

  52. Lifeso RM, Weaver P, Harder EH. Tuberculosis spondylitis in adults. J Bone Joint Surg Am 1985;67:1405–1413.

  53. Miskew DB, Block RA, Witt PF. Aspiration of infected sacroiliac joints. J Bone Joint Surg Am 1979;61(7):1071–1072.

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Published: 2020-04-09
Issue: 2020: Vol 7 No 6 (view)

How to cite:
1.
Darvishi M, Rashidi S, Abazari S. Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report. EJCRIM 2020;7 doi:10.12890/2020_001495.