Sacroiliitis occurring early in the

Sacroiliitis occurring early in the course of the disease is usually the hallmark of ankylosing spondylitis [3, 20]. However, a bilateral and symmetric distribution is observed in ankylosing spondylitis, whereas unilateral abnormalities and the absence of additional manifestations from the spine are most typical in infection, as in the present case. Generally, inflammatory and sero-negative arthritis of the sacroiliac joints is usually bilateral. Peripheral joints manifestations and the other stigmata of the diseases including urithritis, uveitis, rashes and bowel dysfunction are usually observed [3, 24, 33].Osteitis condensans ilii is usually identified on radiographs in young multiparous women following pregnancy. It has been proposed to be the aftermath of ligamentous disruption during pregnancy or parturition. It is a self-limiting condition, rarely leading to chronic sacroiliac joint pain [3]. Metabolic conditions usually affect the sacroiliac joints bilaterally, and are always associated with peripheral manifestations in other joints [3].Definitive diagnosis is obtained by fine needle aspiration or open biopsy [18, 28]. Acid-fast bacilli in direct smears and stains, the growth of the bacilli in the Löwestein-Jensen culture or the granulomatous lesion identified in the histologic specimen will confirm the diagnosis of tuberculosis. Positive culture results and an antibiogram are highly desirable, because fungal infection and brucellosis often yield similar histologic findings [24, 32]. However, false negative results should be anticipated in long standing tuberculosis, due to the paucibacillary nature of the disease [34].Before the advent of chemotherapy, sacroiliac joint arthrodesis was considered of value in hastening the end result, which, regardless of the treatment, was the spontaneous ankylosis of the joint [37]. Kim et al. [21] described two options of operative intervention; joint curettage at the early stages of the disease, or curettage combined with arthrodesis when joint instability is anticipated. Operative results are excellent [20, 34] in terms of residual disease and pain relief.Currently, multiagent anti-tuberculous chemotherapy is used is the treatment of choice for tuberculosis [36, 39]. In the present patient, the authors elected to treat the sacroiliac joint lesion conservatively and to operate directly on the tuberculous abscess to prevent spreading to the hip joint [27]. The patient had an excellent outcome, according to the healing criteria of Kim et al. [21]. Analogous response to either conservative or surgical treatment has also been reported [2, 6, 11, 20, 21, 24, 34, 37, 38]. Recurrences are generally not anticipated [21, 34]