POSTER SECTIONS Coverpage Purpose Methods and materials Results Conclusion Personal information and conflict of interest References

ECR 2020 / C-08321

Tuberculous sacroiliitis

Congress:

ECR 2020

Poster Number:

C-08321

Type:

Scientific Exhibit

Keywords:

Musculoskeletal, Musculoskeletal joint, CT, MR, Biopsy, Drainage, Abscess, Infection, Retrospective, Observational, Performed at one institution

Authors:

A. Kammoun, W. Feki, H. Fourati, E. Daoud, Z. Mnif; Sfax/TN

DOI:

10.26044/ecr2020/C-08321

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-08321

Fig. 1: frequency of tuberculosis scaroiliitis by gender of patients

Fig. 2: Plain antero postero radiograph of the pelvis : widening of the joint space and...

Fig. 3: Plain antero posterior radiograph : destruction of the right sacroiliac joint...

Fig. 4: Plain antero posterior radiograph : widening of the left sacroiliac joint...

Fig. 5: Plain antero posterior radiograph : lytic bone lesion of the sacroiliac margins...

Fig. 6: Chest X-ray : left upper lobe cavitary lung lesion : pulmonary tuberculosis.

Fig. 7: Axial and coronal CT images with bone window reveals osteitis of right ilium...

Fig. 8: Axial and coronal CT images with bone window and axial CT image with soft...

Fig. 9: Axial CT images with soft tissues window reveals widening of the left...

Fig. 10: Axial CT images with soft tissues window reveals widening of the right...

Fig. 11: Bilateral sacroiliitis with widening of the sacroiliac joint, sequestrum,...

Fig. 12: Associated localisations : necrotic lymph nodes of the hepatic helium, soft...

Fig. 13: Axial T2 weighted image, Axial T1 weighted image, and coronal T1 post gado...

Fig. 14: Coronal and axial T1 post gado weighted images : bilateral sacroiliitis with...

Fig. 15: Closed biopsy of the right sacro-iliac

Fig. 16

Fig. 17: Worsening of sacroiliitis under anti tuberculosis treatement

Fig. 18: Improvement of tuberculous sacroiliitis under anti-tuberculosis treatement.

Results

12 cases of tuberculous sacro-iliitis (34,3 %), from 35 infectious sacro-iliitis, were identified in adults, including 8 (67%) women and 4 (33%) men (Figure 1).

The average age of diagnosis was 53 ± 17 years.

The sacro-iliitis was unilateral in 11 (91,7 %) cases, the right joint was effected in 5 cases and the left joint in 6 cases. It was bilateral in one case (8,3 %).

One patient was treated for lymph nodes tuberculosis, another was treated for pericardial tuberculosis.

Low back pain, fever and night sweats were presented in all cases.

Physical examination revealed pain by pressure on the iliac wings ans sacroiliac joints.

Blood test showed inflammation in 11 cases (in 91,7 %, ESR was positive).

Tuberculosis skin test was performed in 7 cases. It was positif in 6 cases (85 %).

Quantiferon-TB-Gold test was performed in 2 cases. It was positif (100%).

Plain antero posterior radiograph was performed in 7 cases. It was abnormal in all cases. It showed :

· Widening of the joint space (n=3) (figure 2,3,4).

· Narrowing of the joint space (n=3).

· Erosions along the joint margins (n=4) (Figure 2).

· Sclerosis (n=5).

· Destructive lesion of the sacro-iliac joint (n=3) (Figure 3,4,5).

Computed tomography (CT) of the pelvis was performed in all cases, it was abnormal in all cases and it showed (figures 7,8,9,10,11) :

· Arthritis in 12 cases.

· Bone sequesters in 7 cases.

· Soft tissues involvement in 9 cases.

· Other associated localisation was diagnosed.

The MRI directed towards the diagnosis in 4 cases. It shows (figures 13,14) :

· Bone marrow oedema.

· Soft tissue involvement : soft tissue swelling and/or abscess.

Closed biopsy of sacro-iliac joint were performed in 5 patients. Histology revealed granuloma and caseation in 3 cases (figure 15).

The puncture of abses (figure 16) was performed in 4 cases, Acid-Fast bassili were isolated and PCR was positif in two patients.

In the other cases, the diagnosis was retained on suggestive clinical and biological arguments.

The delay between the onset of symptoms and the final diagnosis ranged between 100 and 712 days.

The follow up ranged from 1 to 5 years. CT scan was performed in 6 cases and MRI in one case.

Radiological improvement was seen in 3 cases (Figures 17,18).