Infectious sacroiliitis is a rare and challenging diagnosis. Sacroiliac joint changes related to pregnancy and puerperium can predispose to this condition. However, its clinical presentation can often mimic common causes of lower back pain and delay the diagnosis. We report the case of a 31-year-old pregnant woman with twins who presented at 29 weeks of gestation with lower back and right buttock pain that radiated down to the thigh. Although initially interpreted as sciatica pain, the diagnosis of psoas hematoma complicated with infectious sacroiliitis was made. With this case, we aim to bring awareness to this condition in order to raise suspicion among clinicians for an earlier diagnosis.

A previously healthy 26-year-old female presented with one month of worsening low back pain radiating to the right lower extremity. Magnetic resonance imaging (MRI) without contrast of the lumbar spine demonstrated enhancement of the right sacroiliac joint. Sacroiliac joint aspiration followed by culture and microbiology revealed Streptomyces griseus as the cause of infectious sacroiliitis. Streptomyces griseus is a part of the normal human flora that produces a plethora of secondary metabolites applied in various medications such as streptomycin. This represents the first described case of infectious sacroiliitis due to Streptomyces griseus in the literature. It is critical for spinal surgeons to consider fastidious organisms, such as Streptomyces griseus, on the differential diagnosis of sacroiliac joint pain, especially in patients with systemic symptoms and elevated inflammatory laboratory markers.

A 3-month-old intact male Labrador Retriever was presented for falling trauma and hindlimb ataxia. Radiography indicated radiolucent left sacroiliac joint with irregular margin. Computed tomography revealed thickened sublumbar muscles and hypoattenuated sacroiliac joint while magnetic resonance imaging demonstrated abscess at retroperitoneum and gluteal muscle. Ultrasonography showed lytic left sacroiliac joint with retroperitoneal fluid, and fine needle aspiration resulted Staphylococcus aureus. Hindlimb ataxia was attributed to infectious sacroiliitis and its secondary retroperitoneal abscess. As far as the authors\' knowledge, this is the first report of multimodality imaging of infectious sacroiliitis with retroperitoneal abscess caused by S. aureus in a dog.

BACKGROUND: Few infectious sacroiliitis reports are available in the literature. There is no standard clinical presentation, and diagnosis and treatments are therefore usually delayed. We aimed to describe this infection.
METHODS: We performed a single-center retrospective study of patients hospitalized in the infectious diseases unit of the Limoges University Hospital from January 1, 2006 to January 31, 2016. We included all patients presenting with infectious monoarthritis of native sacroiliac joint. Clinical, biological, bacteriological, radiological, and therapeutic characteristics were collected.
RESULTS: A total of 18 patients were enrolled. The sex ratio was 1.25. Mean age was 39.6years (17-69years). The average progression time at diagnosis was 17.9days (1-110days). The mean hospital stay was 16.2days (3-35days). Temperature at admission was 38.8°C (37-40°C). Identified bacteria were methicillin-susceptible Staphylococcus aureus in 83.3% of cases (n=15), Proteus mirabilis (n=1), and Streptococcus dysgalactiae (n=1). Thirty-two (88.9%) of the 36 imaging examinations were consistent with the diagnosis. The survival rate was 100% at the end of the six-month follow-up.
CONCLUSIONS: Infectious sacroiliitis is a complex pathology requiring precise clinical examination for a rapid diagnosis. The outcome is usually favorable.

BACKGROUND: Infectious sacroiliitis (ISI) is an uncommon cause of back and hip pain in which the sacroiliac joint, either unilateral or bilateral, is inflamed from an infectious source. Historically, this has been an easily missed diagnosis due to nonspecific presenting symptoms along with subtle nondistinguishable laboratory abnormalities.
METHODS: We describe an injection drug user presenting with right-sided ISI who presented with hip and back pain and inability to walk. The patient had tenderness over his right sacroiliac joint, and despite negative plain radiographs, a magnetic resonance imaging (MRI) scan was obtained from the Emergency Department (ED) given the patient\'s risk factors for infection. Concerning findings of ISI on this MRI led to a computed tomography-guided biopsy during the patient\'s hospital admission, which revealed alpha-hemolytic Streptococcus as the responsible pathogen. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Infectious sacroiliitis is a rare condition that is difficult to diagnose, and carries increasing morbidity when diagnosis is delayed. We aim to increase awareness through a case report of a patient encountered in the ED.

Infectious sacroiliitis are rare but they can be complicated by disabling functional sequelae. To describe the clinical and bacteriological characteristics of infectious sacroiliitis among patients treated in Sousse Medical Center, Tunisia. A retrospective, descriptive study, of infectious sacroiliitis among patients hositalized in Sousse between 2000 and 2015. The diagnosis was made on the basis of medical signs, imaging, microbiological indicators. In the study were enrolled twenty five patients, 10 men and 15 women; the average age was 41 years (19-78). Sacroiliitis were due to pyogenic bacteria in 14 cases (56%), brucella bacteria in 6 cases (24%) and tuberculosis bacteria in 5 cases (20%). The mean duration of symptoms was 61, 45 and 402 days respectively. The most common clinical signs were buttock pain (92%) and fever (88%). Standard radiographic evaluation was abnormal in 75% of cases. CT scan and MRI of the sacroiliac joints was performed in all cases. The diagnosis was bacteriologically confirmed in 24 cases (96%). The average duration of antibiotic treatment was 83 days in the pyogenic sacroiliitis, and 102 days in brucellar sacroiliitis. The evolution was favorable in 12 patients (48%), 9 patients (36%) had sequelae of sacroiliac joint pain and 4 patients (16%) died. In our study, time frame of infectious sacroiliitis evolution did not predict the causative bacterium, hence the need for bacteriological documentation in order to prescribe appropriate antibiotic therapy.

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