Clostridial sacroiliitis in a patient with fecal incontinence: a case report and review of the literature.

INTRODUCTION Image-guided sacroiliac joint injections are frequently employed for both diagnostic and therapeutic relief of low back pain. CASE REPORT An 83-year-old male with chronic lumbrosacral pain previously responsive to right sacroliac joint injections presented for repeat injection. His medical history included Parkinsonism and stool incontinence. Forty-two hours after the injection, he developed fever, dyspnea, and crepitus on the right buttock and thigh. Surgical debridement was recommended, but the family wished for comfort care only. The patient died hours later. The autopsy revealed Gram positive bacilli consistent with Clostridial myonecrosis. DISCUSSION Pyogenic sacroiliitis is rare and usually occurs in the setting of trauma, drug abuse, or extraspinal infections. Joint infections with Clostridium have been reported after traumatic events including puncture, surgery, and abrasions. Clostridium spores are resistant to chemical preparations used for skin sterilization and require high heat for destruction. Possible practice guidelines with patients that are stool incontinent include mechanical wash prior to sterile preparation and placement of an occlusive sterile dressing after injection to prevent stool contamination of the needle puncture site. As with all rare complications, large scale studies are needed to better identify risk factors to formulate practice management strategies.