J Korean Soc Spine Surg.  2001 Dec;8(4):548-551.

Tuberculous Sacroilitis Associated with Pregnancy: A case report

• Song KJ
• Song SH
• Park HJ

Abstract

Low back pain and gait disturbance began at 6 months of pregnancy in a twenty-eight years old female patient. She could not walk by herself after delivery because of severe pain and limitation of motion on pelvis. Irregular bony destruction on right sacroiliac joint and rotation of pelvis demonstrated on plain radiography. Tuberculosis was confirmed by CT guided needle biopsy. Back pain developing during pregnancy and after delivery can by overlooked as osteitis condensans ilii or nonspecific back pain. Tuberculous sacroilitis should be suspected for the patient with severe pelvic pain and bony destruction on sacroiliac joint, and with rotation of pelvis after delivery. Early diagnosis and proper treatment by anti-tuberculous medication could obtain satisfactory functional outcome. We have described an unusual case of tuberculous sacroiliitis associated with pregnancy in a 28 years old female patient and her clinical presentation, radiological features and outcome of medical treatment are discussed.

Keyword

Sacroiliac joint; Tuberculosis; Pregnancy

MeSH Terms

Adult
Back Pain
Biopsy, Needle
Early Diagnosis
Female
Gait
Humans
Low Back Pain
Osteitis
Pelvic Pain
Pelvis
Pregnancy*
Radiography
Sacroiliac Joint
Sacroiliitis
Tuberculosis

Figure

• 

  Fig. 1. Initial pelvis anteroposterior radiograph showing severe destruction of right sacroiliac joint with internal rotation and proximal migration of right pelvis.

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  Fig. 2. Axial CT scan at the proximal sacroiliac (SI) joint level demonstrating disruption of both SI joint (large arrow) and destruction on right side with abscess formation (small arrow).

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  Fig. 3. Bone scan (99m technetium) shows increased hot uptake at the right SI joint.

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  Fig. 4. Forty-two months followup radiograph of pelvis after initiation of antituberculous medication demonstrating spontaneous fusion of right SI joint and restoration of pelvis to nearly normal position.

Reference

1). Allen AR, Stevenson AW. The results of combined drug therapy and early fusion in bone tuberculosis. J Bone Joint Surg. 39-A:32–42. 1957.

2). Betz RR, Bunnel WP, Lambrecht ME, MacEwen GD. Scoliosis and pregnancy. J Bone Joint Surg. 54-A:90–96. 1987.

3). Demos TC. Radiologic case study. Skeletal tuberculosis. Orthopedics. 3:1222–1236. 1980.

4). HecKman JD. Current concepts review. Musculoskeletal consideration in pregnancy. J Bone Joint Surg. 76-A:1720–1730. 1994.

5). HecKman JD. Managing musculoskeletal problem in pregnant patient. J Musculoskel Med. 1(7):35–40. 1984.

6). Isaacson AS, Whitehouse WM. Spontaneous sacroiliac obliteration in patients with tuberculosis. J Bone Joint Surg. 31-A:306–311. 1949.

7). Kim NH, Lee HM, Yoo JD, Suh JS. Sacroiliac joint tuberculosis. Classification and treatment. Clin Orthop. 358:215–222. 1999.

8). LaBan MM, Perrin JC, Latimer FR. Pregnancy and herniated lumbar disc. Arch Phys Med Rehab. 64:319–321. 1983.

9). Lafond EM. Analysis of adult skeletal tuberculosis. J Bone Joint Surg. 40-A:346–364. 1958.

10). Mantle MJ, Greenwood RM, Currey HLF. B ackache in pregnancy. Rheumat. 16:95–101. 1977.

11). Soholt ST. Tuberculosis of the sacroiliac joint. A review of seventy-five cases. J Bone Joint Surg. 33-A:119–130. 1951.

12). Svensson H, Andersson GBJ, Hagstad A, Jansson P. The relationship of low-back pain to pregnancy and gyne -cologic factors. Spine. 15:371–375. 1990.