Department of Pediatrics, Mount Scopus Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel.
Department of Radiology, Mount Scopus Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Eur J Pediatr. 2019 Apr;178(4):575-579. doi: 10.1007/s00431-019-03333-8. Epub 2019 Feb 7.
Pyogenic sacroiliitis (PS) is rare with less than 100 pediatric cases reported in the medical literature. To better characterize PS in the pediatric population, we investigated a series of children presenting with PS. Retrospective data analysis was done at an academic tertiary center between the years of 2000 and 2017. All hospitalized children ≤ 16 years of age with PS were evaluated. Of the 894 children hospitalized with osteoarticular infections, 18 were diagnosed with PS (2%) and are included in the review. Two clinically distinct groups were identified. PS in infants (n = 13, 72.2%, mean age 1.1 years) had an indolent course and a faster recovery without any bacterial source identified. In contrast, the group of older children (n = 5, 27.8%, mean age 11.6 years) had a more complicated course and a higher rate of identified bacterial infections.Conclusion: We describe an under-recognized entity of PS in infants with a mild clinical course and fast recovery that differ from the "classical" septic sacroiliitis. Infants with PS did not suffer from invasive complications, and pathogen characteristics of older children were not identified. Infants with fever, irritability, decreased range of motion in the pelvic area, and pain during diapering should alert the clinician to this diagnosis. What is Known: • Pediatric pyogenic sacroiliitis is an extremely rare condition usually caused by Staphylococcus aureus with highest incidence in adolescents. • The diagnosis of PS is challenging due to its rarity and difficulty in assessing the sacroiliac joint. What is New: • We describe an under-recognized entity of PS in infants with a mild clinical course, without invasive complications and with fast recovery that differ from "classical" septic sacroiliitis. • Infants with fever, irritability, decreased range of motion in the pelvic area and pain during diapering should raise clinical suspicion of this diagnosis.
化脓性骶髂关节炎（PS）较为罕见，医学文献中报道的儿科病例少于 100 例。为了更好地描述儿科人群中的 PS，我们对一组表现为 PS 的儿童进行了研究。在 2000 年至 2017 年期间，在一家学术性三级中心进行了回顾性数据分析。评估了所有因骨关节感染住院的≤16 岁儿童。在 894 名因骨关节感染住院的儿童中，有 18 名被诊断为 PS（2%），并纳入本研究。确定了两个具有明显临床特征的亚组。婴儿 PS（n=13，72.2%，平均年龄 1.1 岁）表现为一种慢性病程，且无明确细菌来源，恢复较快。相比之下，年龄较大的儿童（n=5，27.8%，平均年龄 11.6 岁）具有更为复杂的病程，且有较高的细菌感染发生率。结论：我们描述了一种在婴儿中不常见的 PS 表现，其临床病程较轻，恢复较快，与“典型”的化脓性骶髂关节炎不同。PS 婴儿未发生侵袭性并发症，也未确定年龄较大儿童的病原体特征。对于出现发热、烦躁、骨盆活动范围减小和尿布更换时疼痛的婴儿，临床医生应警惕这一诊断。已知情况：•儿童化脓性骶髂关节炎是一种极为罕见的疾病，通常由金黄色葡萄球菌引起，青少年发病率最高。•由于该病罕见，且评估骶髂关节困难，因此诊断具有挑战性。新发现：•我们描述了一种在婴儿中不常见的 PS 表现，其临床病程较轻，无侵袭性并发症，且恢复较快，与“典型”的化脓性骶髂关节炎不同。•对于出现发热、烦躁、骨盆活动范围减小和尿布更换时疼痛的婴儿，应提高对此诊断的临床怀疑。
