Isotretinoin-induced sacroiliitis: A rare case report
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Isotretinoin, 13-cis-retinoic acid, is a systemic retinoid acid, which is used for the treatment of various acne lesions that are resistant to other treatments. This is a case of a young 15-year-old male, who developed unilateral sacroiliitis associated with isotretinoin use, and he completely recovered after discontinuing the medication.

The patient presented with an intermittent low grade fever that persisted for 2 weeks, myalgia, and progressive left hip pain. He used no medications, except isotretinoin, which was described to treat his acnes one month ago. On physical examination, pain was felt over the left thigh and hip, and a limited range of motion was noted. Gaenslen's test, thigh thrust test, and Patrick's test were all positive. The muscle power and deep tendon reflex were normal.

Laboratory examinations were carried out. ESR was mildly elevated. HLA-B27 was negative. Bilateral hip plain X-rays revealed blurring and focal bone erosion in the left sacroiliac joint. Hip MRI showed no evidence of septic arthritis or osteomyelitis in the left hip. However, compared with the right side, subchondral marrow edema in the left sacroiliac joint was noted, and sacroiliitis was diagnosed.

Many medications could induce symptoms similar to arthralgia. Isotretinoin should be added to this list of medications. Although not common, the reported prevalence of isotretinoin-induced sacroiliitis is 2.38%–8.20%.5,6 Doctors should be aware of this side effect especially if the patient presented with acute arthritis or inflammatory lower back pain.

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Dr. A●●●●●a B●●●●●●●j Internal Medicine
Very nicely presented 👍
Jun 26, 2020Like