Background: Pyogenic sacroiliitis is a rare infection of sacroiliac joint which accounts for 1-2% of osteoarticular infections in children. The diagnosis of the disease is challenging due to non-specific clinical signs and symptoms, rarity and lack of awareness of physicians. A delay in the diagnosis may cause significant complications such as abscess formation and sepsis. The aim of this study is to analyze and characterize children hospitalized with pyogenic sacroiliitis.
Methods: A retrospective review of all cases of pyogenic sacroiliitis in hospitalized children between the years 2001-2014. An analysis of incidence, age, gender, presenting signs and symptoms, radiologic findings, treatment and outcome was performed.
Results: During the study period 16 children (11 males, mean age 4.4 years) were diagnosed with pyogenic sacroiliitis. The main clinical symptoms were fever, irritability, difficulty in walking or crawling and pain during diapering. Physical signs were mainly sensitivity at the sacroiliac area and decreased range of hip motion. Two different groups were observed. The younger group (11 patients, aged 7-25 months) had an indolent presentation and benign course with neither complications nor positive culture. In the second group (5 patients, mean age11.6 yrs) most (4 of 5) patients had positive blood or pus cultures (mainly Staph. Aureus), 2 had complication including abscess requiring surgical drainage.
Conclusion: Specific clinical and laboratory clues can aid to the early diagnosis of sacroiliitis. In addition, 2 different groups of presentations might reflect a different pathogens involved, specifically Kingella kingae in the younger group.
