title: An unusual sacral osteomyelitis due to an occult anterior sacral meningocele.
abstract: OBJECTIVE
  We present the extremely rare case of sacral osteomyelitis due to an anterior sacral meningocele (ASM) with fistula to the skin. We also discuss the case's clinical significance and the importance of imaging in diagnosis.
  
  
  METHODS
  A 28-year-old female patient was referred to our clinic due to back and hip pain, erythema, and purulent discharge from the right gluteal region. Neurological examination was normal except for pain in the gluteal region. Physical examination revealed a porus lateral to the right gluteal region. Lumbar magnetic resonance imaging (MRI)showed osteomyelitis and a minimal occult sacral meningocele in the anterior sacral region. Contrast-enhanced radiographic imaging clearly showed the fistula tract. The patient underwent surgery via the posterior approach; debridement of the sacral osteomyelitis was performed and the fistula tract toward the skin was closed.
  
  
  RESULTS
  She was pain free after surgery. There were no postoperative complications.
  
  
  CONCLUSIONS
  Although vertebral osteomyelitis due to ASMs is extremely rare, the risk of infection increases in cases of a fistula to the skin. When investigating the etiology of treatment-resistant infections, especially of the skin, sacral osteomyelitis and an underlying anomaly must be kept in mind.
authors.affiliation: Department of Neurosurgery, Diskapi Yildirim Beyazit Training and Research Hospital Ankara, Ankara, Turkey.
authors.forename: Erdal Resit
authors.initials: ER
authors.lastname: Yilmaz
authors.affiliation: Oncology Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey.
authors.forename: Askin Esen
authors.initials: AE
authors.lastname: Hasturk
authors.affiliation: Department of Neurosurgery, Ankara University Hospital, Ankara, Turkey.
authors.forename: Sukru
authors.initials: S
authors.lastname: Caglar
mesh_terms: D000328:Adult; D003646:Debridement / Q000379:methods*; D004890:Erythema / Q000209:etiology; D005260:Female; D005402:Fistula / Q000209:etiology / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008588:Meningocele / Q000150:complications*; D010019:Osteomyelitis / Q000209:etiology*; D010146:Pain / Q000209:etiology; D012445:Sacrococcygeal Region; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome