Infectious pyogenic sacroiliitis following acupuncture: a series of three cases and review of the literature

Background: Acupuncture is an unusual cause of infectious sacroiliitis. Herein, we report three new cases of pyogenic sacroiliitis deemed to be attributable to acupuncture. Case 1: A 45-year-old male underwent 8 acupuncture sessions. He developed inflammatory pain in the left buttock, fever and tachycardia 11 days after the last session. Examination revealed involvement of the left sacroiliac joint. Magnetic resonance imaging (MRI) of the pelvis was consistent with sacroiliitis and blood cultures were positive for Staphylococcus aureus . The final diagnosis was left sacroiliitis caused by S. aureus . He was treated with lincomycin. Case 2: A 55-year-old female who had undergone 10 acupuncture sessions presented with inflammatory gluteal pain 10 days after the last session. Physical examination revealed signs of sacroiliac involvement, confirmed by MRI of the pelvis. The diagnosis was right sacroiliitis complicated by myositis of the gluteal muscles caused by S. aureus . Treatment consisted of antibiotic therapy with amoxicillin and ofloxacin. Case 3: A 72-year-old female who had undergone 10 acupuncture sessions presented 5 days after the last session for inflammatory gluteal pain. On examination, left unipodal weight-bearing was impossible and the tripod sign was present. MRI and clinical findings were in favor of left sacroiliitis associated with infectious pyogenic spondylodiscitis at L4-L5 and paravertebral abscesses. She received empiric antibiotic treatment with amoxicillin and gentamycin, followed by ofloxacin. On the 14th day, the patient unexpectedly died of pulmonary embolism after developing respiratory distress. Conclusion: This case series highlights the continued need for vigilance in the clinical practice of acupuncture.