Sacroiliitis after use of oral isotretinoin - association\nwith acne fulminans or adverse effect?
An 18-year-old male patient had the onset of acne 3 years ago, with worsening in the 40\ndays that preceded the examination at the outpatient clinic. He presented fever and\narthralgias for 7 days, more intense on the sternal region and left shoulder, associated\nwith pustules and confluent nodules which formed crusted erythematous plaques in the\nmalar region, with formation of fistulous tracts in the bilateral mandibular region,\nextending to the preauricular area with purulent secretion (). However, there were no thorax nor dorsum lesions.\nLaboratory exams showed leucocytosis 22,640/mm3 with 78.8% neutrophils,\nwithout hepatic or lipid profile alterations. The drugs in use (topic betamethasone,\ngentamicin and benzoyl peroxide) were suspended and dapsone 100mg/day and minocycline\n100mg/day prescribed for 21 days. With the clinical improvement and normalization of the\nhemogram, oral isotretinoin, 40mg/day (0.67mg/Kg/day) was prescribed. After 30 days\nthere was significant improvement of cutaneous lesions, with pustules more concentrated\non the perioral region, in addition to papules and erythema in the malar and mandibular\nregion, which already showed healing of the fistulous tracts (). At the same time, the patient reported intense lumbar\npain of quick progression, which prevented ambulation, resulting in hospitalization,\nsuspension of isotretinoin and use of analgesics and non-steroidal anti-inflammatory.\nThe lumbar spine radiography and MRI, performed during hospitalization, did not show\nalterations that could explain the clinical condition. After hospital discharge, the\npatient returned to the outpatient clinic using a wheelchair, and an orthopedic\nevaluation was requested. The non-steroidal anti-inflammatory was continued and a bone\nscintigraphy was requested. Bone scintigraphy, done after hospitalization, when the\npatient was already walking with the aid of crutches, detected the radiopharmaceutical\ntrapped in the sacroiliac articulations, which was conclusive for light bilateral\nsacroiliitis (). The HLA-B27 antigen was\nnegative. The patient maintained improvement of the articular condition, with\nprogressive recovery of ambulation after the use of orthesis and physical therapy. The\nacne condition presented excellent results with the use of oral isotretinoin for 30 days\nand after its suspension, benzoyl peroxide 5% associated with adapalene 0.1% and\nintermittent oral antibiotic therapy, showing few inflammatory lesions and residual\nerythema ().