What is the pilonidal cyst sepsis risk?

No study has measured how often this happens, so there is no percentage or rate to give. The evidence is limited to two individual case reports in previously healthy young men, which does not tell us how common or rare this complication is for everyone with pilonidal disease.

What are the warning signs that a pilonidal cyst infection is becoming serious?

In the reported cases, warning signs included high fever, feeling very unwell, a rash, and dangerously low blood pressure that did not improve with usual fluids. If you have a pilonidal cyst and develop these symptoms, seek medical care promptly.

Should I worry every time my pilonidal cyst looks infected?

No. Based on how few cases like this have been reported compared with how common pilonidal disease is, severe systemic infection appears to be rare. Still, watch for high fever, spreading redness, or feeling generally very unwell, and get it checked.

Can a pilonidal cyst cause sepsis?

Name: Can a pilonidal cyst cause sepsis?
Published: 2026-10-26
Keywords: can a pilonidal cyst cause sepsis, pilonidal cyst sepsis risk

In patients with a pilonidal cyst, sinus, or abscess, what is the risk of progression to sepsis or systemic infection, and what factors predict this complication?

How people search for this, in their own words

“can a pilonidal cyst cause sepsis”
“pilonidal cyst sepsis risk”

Evidence review in plain language · compiled 2026-10-26 · checked 2026-10-26 · next 2026-11-26 · automated review, how it works

Bottom line

In rare, individually reported cases, yes — but this has only been documented twice, so it isn't possible to say how often it happens.

Two case reports describe previously healthy young men whose pilonidal abscess or long-neglected pilonidal sinus was followed by life-threatening infection — septic shock in one, toxic shock syndrome and tissue-destroying infection in the other. Both recovered with intensive treatment. No study has tracked a group of people with pilonidal disease to measure how often this complication actually occurs.

How well studied

Little evidence

The only direct evidence is 2 case reports or small series.

This question asks what a condition can lead to, not whether a treatment works, so there is no benefit-or-harm verdict. What can be shown is how well it has been studied.

answer it directly: 2answer it directly
studies found: 6studies found
randomised trials: 0randomised trials
people studied: 57people studied
years covered: 1989–2018years covered

What the research shows

Incidence of sepsis or septicemia
No study has tracked a group of people with pilonidal disease to measure how often sepsis develops. The only evidence is two individual case reports, which cannot be used to calculate a rate.[1,2]
Too little evidence
Bacteremia (bacteria confirmed in the bloodstream)
Neither case report specifically confirmed bacteria in the blood; cultures were taken from the abscess or wound itself.[1,2]
Not studied
Hospitalization for systemic infection
Both reported patients were hospitalized and needed intensive treatment, but with only two cases this cannot show how often hospitalization for this reason occurs among people with pilonidal disease.[1,2]
Too little evidence
ICU admission
Both patients in the case reports required intensive care, but two cases cannot establish how often this happens overall.[1,2]
Too little evidence
Mortality
Both reported patients survived after treatment. This is reassuring but comes from only two cases, so it cannot confirm that death from this complication is rare in general.[1,2]
Not found

What the studies found

Two case reports show that a pilonidal abscess or long-neglected pilonidal sinus can, in rare instances, be followed by severe, life-threatening systemic infection — including toxic shock syndrome and septic shock — in previously healthy young men.[1,2]
In one study, ultrasound scanning was used to look for spread of infection from pilonidal disease into the nearby perianal area (around the anus); the authors judged it accurate for ruling this out, though this was a diagnostic accuracy study, not a study of how often spread actually happens.[1]

Important limitations

The only evidence directly answering this question is two individual case reports, each describing a single patient. There is no cohort study that has followed a group of people with pilonidal disease to see how many develop sepsis.[1,2]
Other studies in this search answer related but different questions: one looked at pilonidal sinus at the umbilicus (belly button), a different body site, and used the word 'sepsis' to mean local wound infection rather than a life-threatening, body-wide reaction.[1]
One report describes a related infection (pyomyositis, pockets of pus within muscle) after pilonidal surgery caused by a toxin-producing bacteria; its statement that this type of bacteria is 'often complicated by severe sepsis' is general background information, not something doctors observed in this particular patient.[1]
A narrative review mentions 'continued sepsis' as a general concept when discussing pilonidal surgery decisions, but reports no data, patient numbers, or actual findings about how often it happens.[1]

What kind of studies

Case series3 · 50%
Prospective cohort1 · 17%
Narrative review1 · 17%
Retrospective1 · 17%

The key studies

Oliveira et al. 2018
Teenage boy with high fever and rash: what could we be missing?
Pilonidal abscess caused severe shockCase seriesVery low quality
1 people4 days
the boy developed sustained low blood pressure unresponsive to fluids and standard drugs, needed intensive care and additional blood-pressure drugs; a sacrococcygeal pilonidal abscess was found and drained, and cultures grew toxin-producing bacteria; he recovered after 4 days
Who was studied
a 15-year-old boy with a pilonidal abscess
Main outcome
development of severe sepsis-like shock (low blood pressure unresponsive to standard treatment) linked to the pilonidal abscess
Quality
it is a single patient case report, so it cannot show how often this happens, only that it can happen
Limitations
single case report, no comparison group, cannot estimate frequency or generalise
Taken word for word from the abstract
- population A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat.
- primaryOutcome develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine
- result A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage. The microbiological culture of abscess material was positive for an enterotoxin-producing Staphylococcus aureus and Peptostreptococcus magnus He was free of symptoms after 4 days.
- n A 15-year-old boy
BMJ Case Rep · PMID 29437816 · Read it on PubMed ↗
Youssef 2015
The value of superficial parts and endoanal ultrasonography in evaluating pilonidal disease and exclusion of perianal sepsis
Ultrasound detects abscesses, rules out spreadProspective cohortLow qualityRelated question
30 people2015
7 of 30 patients had subcutaneous abscesses and 23 had pilonidal sinus tracts; the authors concluded ultrasound was accurate for evaluating the disease and excluding perianal sepsis
Who was studied
people with pilonidal disease referred for ultrasound evaluation
Main outcome
accuracy of ultrasound in evaluating pilonidal disease and ruling out spread of infection to the perianal area
Quality
Small, single-group diagnostic imaging study that reports ultrasound findings and accuracy, not whether pilonidal disease actually leads to sepsis.
Limitations
Only 30 patients, no comparison group, and the study is about diagnostic imaging accuracy rather than tracking whether pilonidal disease progresses to sepsis.
Taken word for word from the abstract
- population Referred 30 patients were clinically diagnosed as pilonidal disease
- n Referred 30 patients were clinically diagnosed as pilonidal disease
- primaryOutcome to assess the value of preoperative evaluation of pilonidal disease and the exclusion of perianal sepsis using superficial parts ultrasonography and endoanal ultrasound
- result 7 patients showed subcutaneous abscesses and 23 patients showed pilonidal sinus tracts.
- result Ultrasonography is an available, inexpensive, safe imaging modality that yields a high degree of accuracy in evaluating pilonidal disease and in exclusion of perianal sepsis.
J Ultrasound · PMID 26261474 · Read it on PubMed ↗
Lorenz et al. 2007
Severe pyomyositis caused by Panton-Valentine leucocidin-positive methicillin-sensitive Staphylococcus aureus complicating a pilonidal cyst
Severe muscle infection after cyst, no sepsis confirmedCase seriesVery low qualityRelated question
1 people2007
The patient developed severe pyomyositis caused by a PVL‑toxin‑producing Staphylococcus aureus after pilonidal cyst surgery and recovered with aggressive antibiotics, surgery and immunoglobulins; the abstract notes that PVL‑positive S. aureus infections in general are 'often complicated by severe sepsis and necrotising pneumonia' but does not report that this particular patient developed sepsis.
Who was studied
a 23-year-old otherwise healthy man who had surgery for a pilonidal cyst
Main outcome
development of severe pyomyositis (multiple muscle abscesses) after pilonidal cyst surgery, with mention of possible progression to sepsis
Quality
This is a single case report of one patient with a rare toxin-producing bacterial strain, so it cannot show how often pilonidal disease leads to sepsis.
Limitations
Only one patient, caused by an unusual PVL-positive MSSA strain, and the sepsis statement is a general background comment about this bacterial toxin rather than an observed outcome in this patient.
Taken word for word from the abstract
- population a 23-year-old apparently healthy male patient without any typical predisposing findings who developed severe pyomyositis secondary to an operated pilonidal cyst
- n a 23-year-old apparently healthy male patient
- primaryOutcome developed severe pyomyositis secondary to an operated pilonidal cyst
- result aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead to recovery from the disease without relapse
- result PVL-positive S. aureus are associated with skin diseases, multiple abscesses and often complicated by severe sepsis and necrotising pneumonia
Langenbecks Arch Surg · PMID 17661075 · Read it on PubMed ↗
Velitchkov et al. 1997
Toxic shock syndrome and necrotizing fasciitis complicating neglected sacrococcygeal pilonidal sinus disease: report of a case
Caused toxic shock and flesh-eating infection.Case seriesVery low quality
1 people1997
The patient developed necrotizing fasciitis and toxic shock syndrome caused by Streptococcus pyogenes and Bacteroides fragilis arising from his neglected pilonidal sinus disease, and he recovered after emergency surgery, repeated debridement, fluid resuscitation, antibiotics, and hyperbaric oxygen.
Who was studied
a previously healthy adult male with neglected sacrococcygeal pilonidal sinus disease
Main outcome
development of life-threatening infectious complications (necrotizing fasciitis and toxic shock syndrome)
Quality
A single case report cannot show how often this happens, only that it can happen.
Limitations
Only one patient; no comparison group; cannot estimate how common this outcome is.
Taken word for word from the abstract
- population a previously healthy adult male patient
- intervention neglected sacrococcygeal pilonidal sinus disease
- primaryOutcome necrotizing fasciitis and toxic shock syndrome, which both complicated neglected sacrococcygeal pilonidal sinus disease
- result developed necrotizing fasciitis and toxic shock syndrome associated with Streptococcus pyogenes and Bacteroides fragilis
- result Patient's response to emergency surgery followed by repeated debridements of necrotic tissue, together with aggressive fluid resuscitation, broad-spectrum antibiotic coverage, and hyperbaric oxygenation was good
- n A case report is presented.
- harm developed necrotizing fasciitis and toxic shock syndrome associated with Streptococcus pyogenes and Bacteroides fragilis
Dis Colon Rectum · PMID 9369118 · Read it on PubMed ↗
Sroujieh et al. 1989
Umbilical sepsis
Local infection, not systemic sepsisRetrospectiveLow qualityRelated question
24 people1989
Most cases of umbilical discharge were due to hair/pilonidal sinus at the umbilicus, presenting with discharge, soreness, swelling and cellulitis; excision of the umbilicus cured the problem
Who was studied
patients with a discharging sinus at the umbilicus, treated surgically
Main outcome
cause and presentation of umbilical discharge/infection (termed 'sepsis')
Quality
small retrospective case series from one hospital describing local umbilical infection, using older terminology where 'sepsis' means local infection rather than systemic/bloodstream sepsis
Limitations
Case series of a different anatomical site (umbilical, not sacrococcygeal) pilonidal sinus; 'sepsis' here refers to local wound infection/cellulitis, not systemic sepsis, so it does not directly test whether pilonidal disease can progress to true systemic sepsis
Taken word for word from the abstract
- population 24 patients who were treated surgically for a discharging umbilical sinus were found
- intervention Treatment by umbilical excision, leaving the skin defect to heal by secondary intention, proved satisfactory
- primaryOutcome Pilonidal sinus of the umbilicus is rarely reported
- result Most of our patients were young men who presented with discharge, soreness or pain, swelling, and cellulitis
- n 24 patients who were treated surgically for a discharging umbilical sinus were found
Br J Surg · PMID 2765801 · Read it on PubMed ↗

All 6 studiesEvery study that answered the question, with its design, size and result.

The other 1 studyEverything else the search returned, including anything retracted.

Purkiss 1993
Decision making in surgery: a pilonidal sinus
No sepsis data reportedNarrative reviewVery low qualityRelated question
size not given1993
The abstract gives no data or findings on sepsis; it only states as a general comment that management decisions may affect prognosis by avoiding recurrence and continued sepsis.
Who was studied
people with pilonidal sinus disease
Main outcome
recurrence and continued sepsis after surgical treatment
Quality
This is a general narrative discussion about surgical decision-making, not a study that measured or reported sepsis occurrence or outcomes.
Limitations
No original data, patient numbers, or outcome measurements are reported; it is an opinion/discussion piece rather than a study of sepsis risk.
Taken word for word from the abstract
- population Pilonidal sinus is an unglamorous surgical condition, often left to juniors, that is difficult to treat.
- primaryOutcome Correct decisions in management may influence the prognosis of the condition by avoiding recurrence and continued sepsis.
- result Correct decisions in management may influence the prognosis of the condition by avoiding recurrence and continued sepsis.
Br J Hosp Med · PMID 8287257 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-26
The exact search — paste this into PubMed to repeat it: ("Pilonidal Sinus"[Mesh] OR pilonidal cyst[tiab] OR pilonidal abscess[tiab] OR pilonidal disease[tiab]) AND ("Sepsis"[Mesh] OR sepsis[tiab] OR septicemia[tiab] OR bacteremia[tiab] OR "systemic inflammatory response syndrome"[tiab] OR septic shock[tiab]); PubMed expanded that to: ("Pilonidal Sinus"[MeSH Terms] OR "pilonidal cyst"[Title/Abstract] OR "pilonidal abscess"[Title/Abstract] OR "pilonidal disease"[Title/Abstract]) AND ("Sepsis"[MeSH Terms] OR "Sepsis"[Title/Abstract] OR "septicemia"[Title/Abstract] OR "bacteremia"[Title/Abstract] OR "systemic inflammatory response syndrome"[Title/Abstract] OR "septic shock"[Title/Abstract])
What came back: 22 records found · 22 read · 6 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Studies mainly about Other causes of sepsis unrelated to pilonidal disease
Studies mainly about Postoperative sepsis after unrelated surgery
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

22records came back from the search
22were read
6actually answered the question

Risks and safetyReported side effects and who should be careful.

In one reported case, a pilonidal abscess was followed by sustained low blood pressure that did not respond to standard fluids, requiring intensive care and extra blood-pressure medication; the cultured bacteria produced a toxin. The patient recovered after four days.
In another reported case, a long-neglected pilonidal sinus was followed by toxic shock syndrome and necrotizing fasciitis (a rapidly spreading, destructive tissue infection); the patient needed emergency surgery, repeated wound cleaning, fluids, antibiotics, and hyperbaric oxygen therapy, and recovered.
One case report describes a man who developed severe pyomyositis (multiple pus-filled pockets in muscle) after surgery for a pilonidal cyst, caused by an uncommon toxin-producing staph bacteria called PVL-positive Staphylococcus aureus; he recovered with antibiotics, surgery, and immune therapy. The report notes that this type of bacteria is often linked to severe sepsis in general, but it does not describe this specific patient as having developed sepsis.

Why people askWhat brings people to this question.

A pilonidal cyst area can look red, swollen, or feel warm, which understandably makes people worry it could turn into a dangerous whole-body infection.
Stories online describing rare severe infections after a pilonidal cyst can make the risk feel more common than it actually is.
People awaiting or recovering from pilonidal surgery often want reassurance about what warning signs would mean something serious is happening.

Common questionsShort answers, drawn from the same studies.

Can a pilonidal cyst cause sepsis?: In rare documented cases, yes — a pilonidal abscess or neglected sinus has been followed by life-threatening systemic infection, including septic shock and toxic shock syndrome. But this comes from only two case reports, so it appears to be uncommon rather than a typical outcome.
What is the pilonidal cyst sepsis risk?: No study has measured how often this happens, so there is no percentage or rate to give. The evidence is limited to two individual case reports in previously healthy young men, which does not tell us how common or rare this complication is for everyone with pilonidal disease.
What are the warning signs that a pilonidal cyst infection is becoming serious?: In the reported cases, warning signs included high fever, feeling very unwell, a rash, and dangerously low blood pressure that did not improve with usual fluids. If you have a pilonidal cyst and develop these symptoms, seek medical care promptly.
Should I worry every time my pilonidal cyst looks infected?: No. Based on how few cases like this have been reported compared with how common pilonidal disease is, severe systemic infection appears to be rare. Still, watch for high fever, spreading redness, or feeling generally very unwell, and get it checked.

What has changedEvery re-check, and whether it changed the answer.

2026-10-26
Clear the 'Under re-review' backlog: rebuild every remaining first-method (ev-1) page under the current method. 3 new studies · 1 no longer retrieved · conclusion possible benefit → not applicable.
The conclusion changed.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.