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Correspondence |

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

Yasuhiro Fujisawa, MD, PhD; Michiko Ito, MD; Yasuhiro Nakamura, MD, PhD; Junichi Furuta, MD, PhD; Yoshiyuki Ishii, MD, PhD; Yasuhiro Kawachi, MD, PhD; Fujio Otsuka, MD, PhD
Arch Dermatol. 2010;146(8):918-935. doi:10.1001/archdermatol.2010.179.
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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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Figure 1.

Clinical and magnetic resonance imaging (MRI) photographs of patients 1 (A and C) and 2 (B and D). A and B, Ulcerations in the left buttocks measured 45 × 45 mm with a 50-mm-deep pocket and 30 × 20 mm with a 50-mm-deep pocket, respectively. C and D, Contrast-enhanced T1-weighted MRI shows ringlike enhancement of the cavity wall (arrows); the arrowheads indicate ischial tuberosity.

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Figure 2.

Hematoxylin-eosin staining of surgical pathologic specimens from patients 1 (A and C) and 2 (B and D). A and B, Cyst walls consisting of fibrous connective tissues, numerous blood vessels, and chronic inflammatory cells (original magnification ×40). C and D, Walls of the cysts have fingerlike projections; the linings of the cysts are composed of a few layers of synovium; and walls of the vessels in the cyst wall are thickened (original magnification ×200).

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