Objective To improve physicians'clinical knowledge regarding tuberculous sacroiliitis.Methods 2 patients who were initially misdiagnosed with spondyloarthritis but subsequently re-diagnosed with tuberculous sacroiliitis were obtained from Department of Rheumatology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University and 13 patients were obtained from relevant literature.Their clinical data were collected and analyzed.Results Among the cohort of 15 cases,8 were female while 7 were male,with a median age of 27 years(range 23-36 years).The median disease duration from the onset of the first symptom to final definitive diagnosis of tuberculous sacroiliitis was 11 months(range 6-24 months).The most prevalent clinical manifestations were buttock pain or lower back pain,observed in 10 and 9 patients respectively.Additional clinical manifestations encompassed fever in 8 patients,weight loss in 3 patients,night sweats in 2 patients,cough in 2 patients,hip pain in 2 patients,and diarrhea in 1 patient.An elevated erythrocyte sedimentation rate was observed in 85.7%(12/14)patients,and elevated C-reactive protein was found in 77.8%(7/9)patients.Positive human leucocyte antigen-B27 was detected in 23.1%(3/13)patients.The purified protein derivative tuberculin skin test was positive in 80.0%(8/10)patients,while the γ-interferon release assay showed positive results in 83.3%(5/6)patients.The tuberculosis deoxyribonucleic acid test showed positive results in 80.0%(4/5)patients,and tuberculosis mycobacterial was successfully cultured in 60.0%(6/10)patients.Radiographic examination of the sacroiliac joints revealed unilateral involvement in 13 cases and bilateral involvement in 2 cases.For the treatment,10 patients were treated with anti-tuberculosis drugs,4 patients underwent lesion debridement of orthopedic surgery combined with anti-tuberculosis drugs,and 1 case underwent lesion debridement alone.All 13 patients who provided follow-up results showed significant improvement.Conclusions Differential diagnosis of spondyloarthritis with tuberculous sacroiliitis should be considered in young patients with lower back or buttock pain.The relevant pathogen tests should be carried out promptly for definitive diagnosis and to avoid misdiagnosis and mistreatment.
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