548 - Deep Gluteal Pain Due to Slowly Progressive Inflammatory Sciatic Neuritis

Case Diagnosis: Autoimmune Inflammatory Sciatic Neuritis

Case Description: A 33 year-old female with history of colitis, presented with a multi-year history of progressive right gluteal pain. Symptomatic colitis symptoms began around the time of the onset of her gluteal pain. However, colitis flares however do not correspond with an increase in her gluteal pain. The patient initially was diagnosed with sacroiliac joint dysfunction, then piriformis syndrome and underwent multiple procedures and ultrasound guided piriformis steroid injections with decreasing efficacy. Due to the worsening pain, Pelvis MRI was obtained and showed diffuse inflammation of the right sciatic nerve in the right gluteal region, without evidence of structural pathology that could cause sciatic nerve compression. Patient was prescribed pregabalin which helped alleviate her symptoms and recommended to return to her gastroenterologist for further evaluation of her inflammatory condition.

Discussions: Deep gluteal pain is a well described pathology of mechanical compression of the sciatic nerve. Deep gluteal pain secondary to sciatic nerve inflammation is less known. Inflammatory sciatic neuritis can be caused by sciatic endometriosis, autoimmune diseases such as colitis, pelvic vascular congestion and others. None of these are well described in the literature but need to be considered when deep gluteal pain does not improve with first line treatment options. Autoimmune sciatic neuritis is a slowly progressive condition and patients are often misdiagnosed until the condition fully declares itself. Early imaging for accurate diagnosis is recommended.

Conclusions: Inflammatory sciatic neuritis is an uncommon condition and poorly described in the literature. This case report describes a clinical course of a likely autoimmune sciatic neuritis.