Tuberculous Sacroiliitis Presenting as a Large Gluteal Abscess

TL;DR

A rare case of tuberculosis affecting the sacroiliac joint presented as a large gluteal abscess and was successfully treated with antituberculous therapy.

Contribution

This case highlights the atypical presentation of tuberculous sacroiliitis as a large gluteal abscess, emphasizing the need for early diagnosis.

Findings

Tuberculous sacroiliitis can present as a large gluteal abscess with nonspecific symptoms.

Xpert MTB/RIF assay confirmed Mycobacterium tuberculosis in the drained abscess.

Standard antituberculous therapy led to clinical improvement in the patient.

Abstract

Tuberculous sacroiliitis is a rare form of extrapulmonary tuberculosis. Its nonspecific clinical presentation often leads to delayed diagnosis and treatment, increasing the risk of severe complications such as deformities and functional limitations. We report the case of a 67-year-old male patient who presented with a progressively enlarging gluteal mass and weight loss. Clinical examination revealed a 20 × 20 cm soft, non-tender mass in the right gluteal region, associated with limited joint mobility. Computed tomography (CT) identified osteolytic lesions in the right sacroiliac joint and a collection in the ipsilateral gluteal region, and both lungs showed disseminated micronodules. The collection was drained, and Xpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) assay detected Mycobacterium tuberculosis. The patient received standard antituberculous therapy for 12 months, resulting in clinical improvement. Tuberculous sacroiliitis requires a high index of suspicion, as delay in treatment may lead to chronic pain and impaired mobility.

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