Tuberculosis remains one of the most common infectious diseases in the world (1).
Musculoskeletal involvement with tuberculosis is uncommon, representing approximately 1 – 3% of cases (2). Sacroiliac joint involvement had been reported in 9.7% to 14 % of patients with skeletal tuberculosis (1–3). It represents 5 to 57% of infectious sacroiliitis (4).
Tuberculous sacroiliitis is responsible for inconspicuous symptoms (1), because of anatomy particularities of this articulation.
Sacroiliac involvement is usually unilateral, but bilateral involvement is possible, found in 6% of cases (4).
The onset of symptoms is generally progressive(4,5). Mean time from symptom onset to diagnosis is from 16 weeks to 14 months in the littérature (1,2,4,6).
Buttock pain and difficulty of walking is the most commun symptoms (1,6).
Fever, anorexia and night sweats are associated usually. Their absence do not rule out the diagnosis.
The ESR is generally moderately high (1,2,4).
The radiological changes require several months to develop (1,4,5).
Plain radiographs may not show any abnormality in the early stage of sacroiliac tuberculosis (7). Haziness or loss of joint line may be an early radiographic finding (7).
CT or MRI are more helpful for early detection of sacroiliac tuberculosis (7).
The tuberculous arthritis is very destructive giving mostly images of erosions. The CT seems the examination of choice for the detection of sequesters (2,4,7), while the MRI is more sensitive for the detection Bone oedema and soft tissue involvement with or without abscess(2,4). MRI may also contribute to the differential diagnosis from a soft tissue tumor or pyogenic arthritis(7).
Definitive diagnosis is obtained by fine needle aspiration or biopsy(4,7).
Acid-fast bacilli in direct smears, the growth of the bacilli in the Lowestein-Jensen culture, amplification of the bacilli genom on PCR (8,9), or the granulomatous lesion with necrosis identified in the histologic specimen confirm the diagnosis (7,9). False negative results should be anticipated in long standing tuberculosis, due to the paucibacillary nature of the disease (4,7).
Tuberculous sacroiliitis is frequently associated with other tuberculous locations. These are most often osteoarticular or pleuropulmonary (2,4).
Currently, multiagent anti-tuberculous chemotherapy is used is the treatment of choice for tuberculosis. Puncture and drainage of abscess can be necessary.
In conclusion, early recognition of sacroiliac tuberculosis is extremely difficult, due mostly to the insidious nature of the disease and the lack of clinical evidence of the disease at the time of initial evaluation. This is why the use of imaging means is essential in early diagnosis.