Iliopsoas abscess: A rare complication of pyogenic sacroiliitis in a child

Pyogenic sacroiliitis is it rare entity in children. Diagnosis is often delayed because of its variable-clinical by the examining physician, and rare findings on radiographs. Delayed diagnosis, however, results to complications such as iliopsoas abscess. We report the case of a 12-year-old girl hospitalized with a 21-day history of fever, pain in the left iliac fossa, and flexion contracture of the hip. On examination, she had fever (38.9 degrees C), psoitis, localized tenderness at the left sacroiliac joint, and pain elicited by lateral compression of the pelvis. The abdominal examination was normal. The erythrocyte sedimentation rate was 130 mm in the first hour, C-reactive protein was 186 mg/l, and the white blood cell count was 18,400/mm(3), with 79% neutrophils. Urinalysis was normal. Blood cultures were negative. Radiographs of the pelvis showed irregular left sacroiliac borders. The CT scan provided the diagnosis of sacroiliitis by an ilioapsoas abcsess. Treatment was based on antibiotic therapy associated with surgical drainage. Bacteriologie investigation revealed Staphylococcus aures. The patient's temperature returned to normal on the second day. Antibioties were continued for 3 months, leading to full recovery. (C) 2009 Elsevier Masson SAS. All rights rcserved.