{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T09:00:31Z","timestamp":1781254831853,"version":"3.54.1"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Tuberculous sacroiliitis is a rare form of osteoarticular tuberculosis and is particularly uncommon in the postpartum period. Its presentation is often nonspecific and can mimic more common postpartum musculoskeletal or infectious conditions, leading to delayed diagnosis, especially in high tuberculosis\u2010endemic regions. We report the case of a 24\u2010year\u2010old woman presenting 10\u2009days postpartum with severe, debilitating right\u2010sided lower back pain and markedly elevated inflammatory markers. Initial evaluation revealed retained products of conception (RPOC), which were managed surgically and with broad\u2010spectrum antibiotics, resulting in biochemical improvement but no clinical relief. A comprehensive rheumatologic work\u2010up was negative. Magnetic resonance imaging of the sacroiliac joint demonstrated unilateral joint effusion, bone marrow edema, joint space widening, and adjacent soft tissue inflammation, features highly suggestive of infectious sacroiliitis. In the context of a tuberculosis\u2010endemic setting, lack of response to conventional antibiotics, negative blood cultures, and characteristic MRI findings, a diagnosis of presumed tuberculous sacroiliitis was made. The patient was started on empirical anti\u2010tuberculous therapy with a standard four\u2010drug regimen, followed by continuation therapy. She showed marked clinical improvement with resolution of pain and restoration of mobility. Follow\u2010up MRI at 7\u2009months demonstrated significant regression of inflammatory changes, confirming an excellent treatment response and no evidence of ongoing infection. This case highlights the importance of maintaining a high index of suspicion for tuberculous sacroiliitis in postpartum women from tuberculosis\u2010endemic regions presenting with severe, refractory lower back pain. Early MRI plays a pivotal role in diagnosis when routine investigations are inconclusive. Prompt initiation of empirical anti\u2010tuberculous therapy, even in the absence of microbiological confirmation, can lead to excellent outcomes and prevent long\u2010term joint damage.<\/jats:p>","DOI":"10.1002\/ccr3.72413","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T03:49:07Z","timestamp":1775447347000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Probable Case of Postpartum Sacroiliac Joint Tuberculosis: The Diagnostic Value of Imaging in a High\u2010Endemic Setting"],"prefix":"10.1002","volume":"14","author":[{"given":"H. Saad","family":"Nasir","sequence":"first","affiliation":[{"name":"The Aga Khan University Hospital  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huda","family":"Raja","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Nadeem","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuja","family":"Shaukat","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabih","family":"Ayesha","sequence":"additional","affiliation":[{"name":"Chiniot General Hospital  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9536-1665","authenticated-orcid":false,"given":"Nahid","family":"Khalid Raufi","sequence":"additional","affiliation":[{"name":"Department of Medicine Kabul Medical University  Kabul Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,5]]},"reference":[{"issue":"9","key":"e_1_2_15_2_1","first-page":"565","article-title":"Magnetic Resonance Imaging of Tuberculous Sacroiliitis","volume":"34","author":"McQueen F. 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E.","year":"2001","journal-title":"Journal of the Southern Orthopaedic Association"},{"key":"e_1_2_15_8_1","first-page":"214","article-title":"Septic sacroiliitis","volume":"313","author":"Osman A. A.","year":"1995","journal-title":"Clinical Orthopaedics and Related Research"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-006-0132-9"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199901000-00026"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199505150-00015"},{"issue":"6","key":"e_1_2_15_12_1","first-page":"576","article-title":"Immune Changes in Pregnancy and Postpartum: Implications for Tuberculosis Management","volume":"24","author":"Mittal S.","year":"2020","journal-title":"International Journal of Tuberculosis and Lung Disease"},{"issue":"4","key":"e_1_2_15_13_1","first-page":"225","article-title":"Septic Sacroiliitis in a Postpartum Patient With Retained Products of Conception","volume":"20","author":"Chen C. P.","year":"2014","journal-title":"Journal of Clinical Rheumatology"},{"issue":"6","key":"e_1_2_15_14_1","first-page":"884","article-title":"Effect of Mechanical Stress on Magnetic Resonance Imaging of the Sacroiliac Joints: Assessing the Validity of the Berlin Algorithm","volume":"71","author":"Varkas G.","year":"2019","journal-title":"Arthritis and Rheumatology"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2021.101707"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.5288"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72413","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72413","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72413","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:42:12Z","timestamp":1781253732000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72413"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/ccr3.72413"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72413","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-10-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72413"}}