SHM Converge Scientific Abstract ePoster Gallery-Rare Case of Sacroiliac Septic Arthritis After Chemical Abortion

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A 24-year-old woman developed progressive left lower back and buttock pain one month after a first-trimester chemical abortion using methotrexate. Two weeks before admission, she had fever, malaise, tachycardia, and vaginal discharge and was treated in the ER for presumed endometritis with IV fluids and a week of cephalexin. Gynecologic follow-up, pelvic exam, and ultrasound found no retained products of conception, but her symptoms persisted.<br /><br />On presentation, exam showed focal tenderness over the left lower back and buttock. Inflammatory markers were markedly elevated, with ESR 121 mm/hr and CRP 11.1 mg/L. MRI of the pelvis revealed left sacroiliitis extending into the left gluteus minimus, consistent with septic sacroiliac arthritis. She was started on empiric vancomycin and ceftriaxone, then transitioned to oral amoxicillin-clavulanate and levofloxacin for a total of six weeks. Her pain improved, and ESR/CRP trended down on follow-up.<br /><br />The report emphasizes that septic sacroiliitis is a rare but serious complication of chemical abortion. Septic arthritis of the sacroiliac joint accounts for only 1.5% to 10% of septic arthritis cases and is associated with gynecologic infections, trauma, or drug use. Symptoms are often nonspecific, especially around pregnancy or the postpartum period, which can delay diagnosis and increase the risk of joint damage and systemic complications such as bacteremia or endocarditis.<br /><br />The authors note that no prior cases of sacroiliitis after chemical abortion were found in their literature review, making this an unusual and clinically important presentation.

Asset Subtitle

Tanveer Singh

Meta Tag

Author List Meenu Gaba, Tanureet K. Arora, Tanveer Singh, Umang Singhal

Category Clinical Vignettes

Concept Sacroiliac Septic Arthritis

Concept Empiric Antibiotic Therapy

Concept Magnetic Resonance Imaging

Concept Erythrocyte Sedimentation Rate

Concept C-reactive protein

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic

Presenting Author Tanveer Singh

Track Adult

Keywords

septic sacroiliitis

chemical abortion

methotrexate

left lower back pain

buttock pain

pelvic MRI

endometritis

inflammatory markers

sacroiliac joint infection

gynecologic complication

Sacroiliac Septic Arthritis

Empiric Antibiotic Therapy

Magnetic Resonance Imaging

Erythrocyte Sedimentation Rate

C-reactive protein