Postpartum Enterobacter Pyogenic Sacroiliitis

Postpartum pyogenic sacroiliitis is a rare condition. Accurate diagnosis is frequently delayed because of poor localization of initial symptoms and the rarity of this disorder. Pyogenic sacroiliitis has been related to trauma, intravenous drug abuse, and gynecological infections1-3, but it is rare without a predisposing factor. We report the case of a thirty-one-year-old woman with postpartum pyogenic sacroiliitis caused by the Enterobacter species, and we also provide a review of the pertinent literature. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A thirty-one-year-old woman (gravida 4, para 4) presented to our emergency department with symptoms of fever and pain in the right buttock for three days. The pain had begun two hours after a normal vaginal delivery. The past medical history noted sclerotherapy for varicose veins on both lower extremities two years earlier. The patient denied any recent history of intramuscular drug injection. Vital signs included a temperature of 38.8°C and a pulse rate of 99. On physical examination, there was limitation of right hip motion and a positive test for flexion, abduction, and external rotation (FABER). The right leg had normal muscle strength, with no swelling, warmth, or erythema. Laboratory studies, including complete blood-cell count as well as kidney and liver function tests, were normal except for leukocytosis (white blood-cell count: 14 × 109/L; lymphocytes: 9%; neutrophils: 84%), an elevated C-reactive protein level of 132 mg/L (normal, less than 5 mg/L), and an elevated erythrocyte sedimentation rate of 110 mm/h (normal, 0 to 15 mm/h). The urinalysis and the subsequent urine culture specimen were negative. The rose bengal test for Brucella was also negative. The patient was admitted to the hospital with a diagnosis of postpartum pyrexia and was administered ceftriaxone (1 gm …