Tuberculous Spondylodiscitis with Sacroiliac Joint Involvement

Şimşek, Sadullah; Karaca, Mehmet Salih; Sağlam, Tarık

doi:10.1590/0037-8682-0363-2025

A 50-year-old woman presented with a 1 -year history of progressively worsening low back and hip pain, accompanied by a 10 kg weight loss. Laboratory evaluation revealed elevated inflammatory markers (erythrocyte sedimentation rate: 27 mm/h; C-reactive protein: 22 mg/L). Contrast-enhanced magnetic resonance imaging (MRI) revealed endplate irregularities, edema, disc space narrowing, and vertebral enhancement at T6-7, consistent with spondylitis. At L3-L4, MRI showed endplate destruction, edema, and intervertebral disc damage with marked enhancement, indicative of spondylodiscitis. T2-weighted images revealed hyperintense signals in the right sacroiliac joint, with postcontrast enhancement of the joint, adjacent bone, and surrounding soft tissues, consistent with sacroiliitis (Figure 1). A Quantiferon test performed for suspected tuberculosis was positive (TB2 antigen: 0.98). The patient was treated with a 6-month antituberculosis regimen, leading to clinical improvement and marked radiologic regression on follow-up MRI (Figure 2).

FIGURE 1:
Magnetic resonance imaging of the thoracic and lumbar spine and right sacroiliac joint. T2-weighted images (A-C) demonstrate areas of high signal intensity (arrows), while postcontrast images (D-F) show corresponding contrast enhancement (arrows).

FIGURE 2:
Follow-up magnetic resonance imaging after 6 months of antituberculosis treatment reveals decreased signal intensity on T2-weighted images (A-C, arrows) and reduced contrast enhancement on postcontrast images (D-F, arrows).

Bone and joint tuberculosis constitutes a small proportion of all tuberculosis cases but can cause substantial morbidity. Spinal tuberculosis is the most common form, with an incidence of 2.4-7.2 per 100,000 in developed countries¹. Sacroiliac joint involvement is uncommon, accounting for 3-9.7% of musculoskeletal tuberculosis². Coexisting sacroiliac and spinal involvement complicates diagnosis.

ACKNOWLEDGMENTS

No.

REFERENCES

¹ Naselli N, Facchini G, Lima GM, Evangelisti G, Ponti F, Miceli M, et al. MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis. Eur Spine J. 2022;31(2):431-41.
² Eren B, Guzey FK, Aktas OY, Gulec I, Bas NS. Lumbar tuberculous spondylodiscitis, sacroiliitis and paraspinal abscess with Staphylococcus aureus superinfection. J Clin Exp Orthop. 2018;4.

Financial Support:
None.

Edited by

Associated Editor:
Manoel O. da Costa Rocha Orcid: https://orcid.org/0000-0002-4721-1767

Publication Dates

Publication in this collection
09 Feb 2026
Date of issue
2026

History

Received
24 Aug 2025
Accepted
29 Sept 2025

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹ Naselli N, Facchini G, Lima GM, Evangelisti G, Ponti F, Miceli M, et al. MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis. Eur Spine J. 2022;31(2):431-41.

[2] ² Eren B, Guzey FK, Aktas OY, Gulec I, Bas NS. Lumbar tuberculous spondylodiscitis, sacroiliitis and paraspinal abscess with Staphylococcus aureus superinfection. J Clin Exp Orthop. 2018;4.