RADIOLOGICAL SPECTRUM OF INFECTIOUS SACROILIITIS: A RETROSPECTIVE, STUDY OF 40 ADULTS.

Dr Ravikant Kaushik, Dr Shubhda Sagar, Dr. Mukta Mital, Dr Sunil Malhotra, Dr Sonal Saran, Dr Abhay Pratap Singh, Dr. Kaustabh Gupta

Abstract


Purpose:The purpose of this study was to assess the demographic and clinical profile of patients presenting with
infective sacroiliitis and to identify the MRI features that aid in the diagnosis of infective sacroiliitis.
Materials and Methods:This retrospective study included all ISI cases diagnosed between 2017 (september) and 2019(April) in radiodiagnosis
department of Subharti Medical College. ISI was diagnosed if sacroiliitis was confirmed bacteriologically or, in the absence of pathogenic
agents, if clinical, biological, and radiological data was compatible with this diagnosis and evolution was favourable under antibiotic therapy.
MRI findings were correlated with clinical data, including age and duration of disease.
RESULTS:Overall, 40 cases of ISI were identified in adults, comprising 22 women and 18 men, with a mean age of 40.4 ± 18.1 years. Majority
of the study population (67.5%) were between 21-40 years of age. All 40 patients complained of low back pain (100%) while 29 (72.5%) showed
restricted spine movement. 29 out of 40 patients (72.5%) were febrile (mean temperature 37.8 ± 1°C) and hip pain was showed by 21 (52.5%)
patients. CRP (n = 40) was elevated (mean, 9.62 mg/dL), Leukocytosis (n = 33) was only observed in 82.5% of patients (mean, 14,904 cells/μL)..
Magnetic resonance imaging (MRI) of SI joint made the diagnosis to ISI in 40 cases. Unilateral ISI was diagnosed in 31 patients and bilateral ISI
was diagnosed in 9 patients. Pathogenic agents were isolated in 25 cases. Mycobacterium Tuberculosis was the mostly isolated common
bacteria. Others incluse streptococci, staphylococci and Pseudomonas aeruginosa. MRI features like bone marrow edema was noted in all the
patients followed by periarticular muscle edema and capsulitis. Bony erosion were noted in long standing cases of ISI. Extracapsular fluid
collection and joint space widening were the other important findings of ISI.
Conclusion:Our study confirmed that the clinical manifestations of ISI usually lead to delayed diagnosis. Based on our results, we suggest
performing an MRI of the spine and SI in clinical situations characterised by lumbogluteal pain and symptoms of an infectious disease, such as fever
helps in early diagnosis of ISI Firstly, bone marrow oedema with intra-articular fluid. Second, inflammation to involve the peri-articular soft tissues,
particularly the iliacus and gluteal muscles. Third, peri-articular fluid collection or abscess is practically pathognomonic of an infective sacroiliitis


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