Sacroiliac Joint Tuberculosis With Concomitant Iliopsoas Abscess Suggesting a Diagnostic and Therapeutic Challenge: A Case Report.

Sacroiliac joint (SIJ) tuberculosis (TB) is an infrequent clinical entity, especially in developed countries. The symptoms are usually non-specific, and therefore it may mimic a variety of degenerative and non-degenerative diseases, hampering the diagnosis. An interesting case of SIJ infection with psoas abscess in a 77-year-old male is presented in the current article. The patient presented to the Infectious Diseases Clinic complaining of prolonged fever and difficulty walking. The fever was intermittent, it appeared usually at night, and it reached up to 39 degrees Celsius and was accompanied by chills. Magnetic resonance imaging (MRI) indicated SIJ osteomyelitis accompanied by two iliopsoas abscesses above the joint. Computed tomography (CT)-guided aspiration of the abscess was performed twice, but the microbiological culture did not grow any pathogens; Gene-X-Pert performed on the drained pus was negative. An open biopsy with drainage of the abscess cavities and bone biopsy was performed and set the diagnosis, and the anti-TB treatment was initiated. Shortly after the surgical procedure, the patient developed confusion and relapse of high-grade fever, and tubercular meningoencephalitis was diagnosed following an MRI of the brain, which revealed compatible lesions. The patient was intubated and transferred to the intensive care unit (ICU). A quadruple anti-TB regimen was administered. However, the patient's condition deteriorated as he developed necrosis in the cortex and basal ganglia and the outcome was fatal. This article aims to raise awareness regarding this rare clinical entity, whose diagnostic and therapeutic management is particularly demanding.