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August 16, 2010

Perforated Ischiogluteal Bursitis Mimicking a Gluteal Decubitus Ulcer in Patients With Spinal Cord Injury: Report of 2 Cases

Author Affiliations

Author Affiliations: Department of Dermatology, University of Tsukuba, Tsukuba, Japan.


Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Dermatol. 2010;146(8):918-935. doi:10.1001/archdermatol.2010.179

The ischiogluteal bursa is an inconsistent anatomic finding, located between the ischial tuberosity and the gluteus maximus. When a bursa becomes inflamed, it appears as a red swelling near a joint and may present as a soft-tissue mass. Though a rare condition, ischiogluteal bursitis (IB) may perforate and appear as a skin ulcer with a deep pocket mimicking a decubitus ulcer. Since IB has no specific clinical features, radiologic imaging and pathologic analysis are helpful in the diagnosis. Magnetic resonance imaging and computed tomography scans show an irregularly thickened wall with contrast enhancement attached to the ischial tuberosity.1 Pathologic specimens show the walls of the cyst to have fingerlike projections consisting of fibrous connective tissues and inflammatory cell infiltration. The lining of the cyst comprises a few layers of synovial or eosinophilic fibrinoid material.2 Since IB resists conventional antiulcer therapy, complete resection of the bursa is required, and in some cases flap surgery must be performed to provide a secure cushion.3

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