Misdiagnosis of postpartum lower back pain: Report of a rare septic arthritis

Abstract

Sacroiliac septic arthritis is an osteoarticular infection of the sacroiliac joint caused by various microorganisms, often bacterial. This report a case of postpartum septic sacroiliitis. On day six postpartum, a young mother presented with sudden onset of severe lower back pain, radiating to her left gluteal, following an uncomplicated vaginal delivery. Unable to weight bear, she was rendered immobile. X-ray findings were inconclusive. She was treated for prolapsed intervertebral disc and discharged. With no signs of improvement, three weeks later, at day 27 postpartum, an outpatient magnetic resonance imaging of spine and pelvis revealed left sacroiliac septic arthritis. Positive septic workup supported imaging findings. Definitive treatment was commenced. Within two months, the pain improved and she steadily mobilized again. Nonetheless, she still had residual pain likely due to possible joint destruction and/or fusion. She was managed appropriately. A year later, the pain was still there. In conclusion, better understanding of disease matter, right imaging tools for disease detection and high index of suspicion are paramount to avoid misdiagnosis. Management should surpass medical/surgical treatment, especially for those with poor prognosis. We should focus on improving patient’s quality of life apart from treating the actual disease.