doiSerbia

Pyogenic arthritis of sacroiliac joint in children

Rakonjac Zoran (Klinika za dječiju hirurgiju, Banja Luka, Bosna i Hercegovina)
Brdar Radivoj (Univerzitetska dečja klinika, Beograd)
Šatara Mirko (Klinika za dječiju hirurgiju, Banja Luka, Bosna i Hercegovina)

Introduction Pyogenic infection of sacroiliac joint (SIJ) is very rare in children. It is the result of haematogenous spread primarily affecting the joint. The process is usually monoarticular. By rule, sequestra are rarely formed, there are no greater bone destructions, but there is usually early bone sclerosing. Case outline Due to the pain in the lumbosacral area spreading down the right leg and positive Lazarevic's sign, a 13-yearold boy was referred to a neuropediatrician. He was suffering from lumbosciatica. In the first three sick days, laboratory tests were done as well as X-ray examination. High febrility and laboratory results indicated the existence of infection of unknown localization. Diagnostic examination: radiography of the lungs and heart, computerized tomography (CT), nuclear magnetic resonance (NMR), ultrasound (US) of hips and painful sacroiliac area and US of abdomen could not localise the infection. Radiography of SIJ (Barschoni) focused the attention on SIJ. Scintigraphy of the skeleton with 99mTc-DPD pointed to the intensified collection of radiopharmaceuticals in the area around SIJ. Localized changes, erythema and signs of abscess in the projection of SIJ appeared the fifth day since the appearance of the disease. Incision was performed as well as evacuation of purulent content, and bacterial analysis isolated Staphylococcus aureus. Therapy with antibiotics was applied according to the antibiogram three weeks parenterally (intravenously) and two weeks per os. After five weeks, clinical and laboratory results were normal. The patient has been monitored for eight months since the appearance of the disease. Conclusion In children with symptoms and signs of lumbosciatica, among other things, attention should be paid, differentially and diagnostically speaking, to pyogenic infection of SIJ. The skeletal scintigraphy helps early diagnosis of pyogenic infection of SIJ, when localized clinical signs have not been formed yet. In our patient, the infection was caused by localized spreading from a skin abrasion.

Keywords: pyogenic arthritis, sacroiliac joint, children