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Allen KamravaMD · MBA · FACS · FASCRS

Can a pilonidal cyst cause sepsis?

In patients with pilonidal cyst or sinus disease, what is the incidence of sepsis or systemic bloodstream infection arising from the cyst, and what factors increase that risk?

How people search for this, in their own words

  • “can a pilonidal cyst cause sepsis”

Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

What the evidence says

Bottom line

Yes — in rare, documented cases, a pilonidal cyst or sinus has led to severe, body-wide infection including sepsis, but how often this happens is not known.

This comes from only three case reports, each describing a single patient, not from studies that tracked many people over time. In these reports, patients recovered when the infection was caught and treated quickly and aggressively with drainage, antibiotics, and sometimes other intensive care. No study has counted how many people with a pilonidal cyst actually develop sepsis, so the true risk cannot be stated as a number.

How well studied

Under re-review

This page is being re-checked under a revised method that first confirms each study answers this exact question. Until that is done, no level is shown.

This question asks what a condition can lead to, not whether a treatment works, so there is no benefit-or-harm verdict.

answer it directly
3answer it directly
studies found
4studies found
randomised trials
0randomised trials
people studied
13people studied
years covered
1997–2018years covered

What the research shows

  • Incidence of sepsis or septic shock

    No study tracked a group of people with pilonidal cysts to see how many developed sepsis. The evidence is single case reports of it happening, not a count of how often it happens.[1,2]

    Not studied

  • Bacteremia or positive blood cultures

    One case report found toxin-producing bacteria infecting the abscess, but this is one patient, not evidence of how often bacteria spread into the bloodstream.[1]

    Too little evidence

  • Hospital admission for systemic infection

    The reported patients were clearly unwell enough to need hospital treatment, but with only single-patient reports, no rate of hospital admission can be calculated.[1,2,3]

    Too little evidence

  • ICU admission

    Some reports describe care (such as blood pressure not responding to fluids, or hyperbaric oxygen) that suggests intensive care, but this was not reported as a distinct outcome.[1,2]

    Too little evidence

  • Sepsis-related mortality

    The patients in these case reports survived. No study has measured how often severe infection from a pilonidal cyst is fatal.[1,2,3]

    Not studied

  • Time from symptom onset to systemic infection

    No study measured how long it takes for a pilonidal cyst to progress to a severe, body-wide infection.[1,2,3]

    Not studied

What the studies found

  • In the few reported cases of severe infection, patients recovered when they received prompt, aggressive treatment: surgical drainage, antibiotics, and in some cases also immunoglobulins or hyperbaric oxygen (breathing pure oxygen in a pressurised chamber).[1,2,3]

Important limitations

  • All of the direct evidence is single case reports, one patient each, with no comparison group of people whose pilonidal cyst did not turn into a severe infection. This makes it impossible to know how common this is.[1,2,3]
  • One study looked at a different problem: infection of the spine after a spinal injection given during pilonidal surgery, not infection spreading from the cyst itself. It could not even show that the injection caused the infection.[1]
  • The reported cases involved specific circumstances, such as a toxin-producing bacterium or years of untreated disease, that may not apply to most people with a pilonidal cyst.[1,2,3]

What kind of studies

  • Case series3 · 75%
  • Narrative review1 · 25%

The key studies

  • Oliveira et al. 2018

    Teenage boy with high fever and rash: what could we be missing?

    Pilonidal abscess caused severe shock.Case seriesVery low quality

    1 people4 days

    The boy developed low blood pressure unresponsive to fluids, was found to have a pilonidal abscess infected with toxin-producing bacteria, and recovered after drainage and antibiotics

    Who was studied
    15-year-old boy with high fever and rash
    What they received
    no treatment intervention studied (case report of pilonidal abscess causing illness)
    Compared with
    none
    Main outcome
    development of severe infection (sepsis/shock) from pilonidal abscess
    Quality
    This is a single patient case report, so it cannot show how often this happens or prove cause and effect.
    Limitations
    Single case report with no comparison group; cannot establish how common this complication is.

    Taken word for word from the abstract

    • n A 15-year-old boy was admitted
    • population A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat.
    • intervention A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage.
    • comparator This case report summarises a potential severe complication of the pilonidal disease.
    • primaryOutcome develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine
    • result 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.

    BMJ Case Rep · PMID 29437816 · Read it on PubMed ↗

  • Lorenz et al. 2007

    Severe pyomyositis caused by Panton-Valentine leucocidin-positive methicillin-sensitive Staphylococcus aureus complicating a pilonidal cyst

    Pilonidal cyst led to severe muscle infection, sepsis riskCase seriesVery low quality

    1 peoplenot specified beyond 'in the follow-up' and 'without relapse'

    patient recovered without relapse after intensive treatment

    Who was studied
    23-year-old healthy man with an operated pilonidal cyst
    What they received
    aggressive antibiotic and surgical treatment plus immunoglobulins
    Compared with
    none
    Main outcome
    recovery from severe muscle infection (pyomyositis)
    Quality
    this is a single patient case report, so it cannot show how often this happens or prove cause and effect
    Limitations
    only one patient described, no comparison group, specific rare bacterial toxin involved

    Taken word for word from the abstract

    • n a 23-year-old apparently healthy male patient
    • population a 23-year-old apparently healthy male patient without any typical predisposing findings who developed severe pyomyositis secondary to an operated pilonidal cyst
    • intervention aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead to recovery from the disease without relapse
    • comparator CASE REPORT
    • primaryOutcome recovery from the disease without relapse
    • result aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead to recovery from the disease without relapse

    Langenbecks Arch Surg · PMID 17661075 · Read it on PubMed ↗

  • Pavón Benito et al. 2007

    [Infectious spondylodiskitis and epidural abscess after spinal puncture for pilonidal sinus excision]

    Rare spine infection after spinal punctureNarrative reviewVery low qualityRelated question

    10 people2007

    the incidence of these infections after puncture does not exceed that of spontaneous epidural abscesses, so a causal link to the puncture is uncertain

    Who was studied
    patients who developed vertebral infections after spinal puncture performed during pilonidal sinus excision surgery
    What they received
    spinal puncture used for anesthesia during surgery
    Compared with
    spontaneous epidural abscess occurrence (not related to puncture)
    Main outcome
    development of vertebral or epidural infection after spinal puncture
    Quality
    This is a review of only 10 previously published cases with inconsistent reporting of sterility and infection history, so it cannot reliably show cause and effect.
    Limitations
    Only half of the 10 cases reported on aseptic conditions, only 2 had a prior infection noted, and half did not even describe the type of puncture used.

    Taken word for word from the abstract

    • n After analyzing 10 published cases
    • population Vertebral infections after spinal puncture are rare and often inadequately documented.
    • intervention spinal puncture
    • comparator Their incidence does not exceed that of spontaneous epidural abscesses
    • primaryOutcome Vertebral infections after spinal puncture are rare and often inadequately documented.
    • result Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess.

    Rev Esp Anestesiol Reanim · PMID 17319435 · Read it on PubMed ↗

  • Velitchkov et al. 1997

    Toxic shock syndrome and necrotizing fasciitis complicating neglected sacrococcygeal pilonidal sinus disease: report of a case

    Case seriesVery low quality

    1 people1997

    the patient recovered well after aggressive combined treatment

    Who was studied
    an adult man with neglected pilonidal sinus disease at the base of the spine
    What they received
    emergency surgery with repeated removal of dead tissue, fluids, antibiotics, and hyperbaric oxygen treatment
    Compared with
    none
    Main outcome
    survival and recovery from severe infection (necrotizing fasciitis and toxic shock syndrome)
    Quality
    this is a single patient case report, so it cannot show how often this happens or what causes it.
    Limitations
    only one patient described, no comparison group, treatment response may not generalize

    Taken word for word from the abstract

    • population a previously healthy adult male patient who developed necrotizing fasciitis and toxic shock syndrome associated with Streptococcus pyogenes and Bacteroides fragilis
    • intervention emergency surgery followed by repeated debridements of necrotic tissue, together with aggressive fluid resuscitation, broad-spectrum antibiotic coverage, and hyperbaric oxygenation
    • comparator A case report is presented.
    • primaryOutcome 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.
    • 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 We describe the rare case of a previously healthy adult male patient

    Dis Colon Rectum · PMID 9369118 · Read it on PubMed ↗

All 4 studiesEvery study that answered the question, with its design, size and result.
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 2026-10-13
The exact search — paste this into PubMed to repeat it
"Pilonidal Sinus"[Mesh] AND ("Sepsis"[Mesh] OR "Systemic Inflammatory Response Syndrome"[Mesh] OR "Bacteremia"[Mesh] OR "Septic Shock"[tiab] OR sepsis[tiab] OR septicemia[tiab])
PubMed expanded that to: "Pilonidal Sinus"[MeSH Terms] AND ("Sepsis"[MeSH Terms] OR "Systemic Inflammatory Response Syndrome"[MeSH Terms] OR "Bacteremia"[MeSH Terms] OR "Septic Shock"[Title/Abstract] OR "Sepsis"[Title/Abstract] OR "septicemia"[Title/Abstract])
What came back
19 records found · 19 read · 4 answered the question
Included
  • Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded
  • Records about a different condition or intervention
  • 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.

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.

How we grade evidence →

  1. 19records came back from the search
  2. 19were read
  3. 4actually answered the question
Risks and safetyReported side effects and who should be careful.
  • Severe, body-wide infection (sepsis) has been reported after a pilonidal abscess, including blood pressure that did not respond to fluids until the abscess was drained and antibiotics given.
  • Toxic shock syndrome and necrotising fasciitis (a rapidly spreading, life-threatening infection of the skin and tissue) have been reported with a long-neglected pilonidal sinus.
  • A severe muscle infection (pyomyositis) caused by a toxin-producing staph bacteria has been reported as a complication of a pilonidal cyst.
Why people askWhat brings people to this question.
  • A pilonidal cyst can look alarming when it is red, swollen, and draining, which makes it natural to worry it could turn into a serious, whole-body infection.
  • Stories online or from other patients about pilonidal infections becoming severe can raise fear, even though such outcomes are rarely described in medical literature.
  • Pain, fever, or feeling unwell alongside a cyst flare can feel like a sign that the infection is spreading, prompting someone to search for how serious it could become.
Common questionsShort answers, drawn from the same studies.
Can a pilonidal cyst cause sepsis?
In rare, documented cases, yes. Case reports describe pilonidal cysts or sinuses leading to sepsis, toxic shock syndrome, or a severe muscle infection. These are single-patient reports, not studies measuring how common this is, so the real-world risk is unknown.
How common is sepsis from a pilonidal cyst?
No study has measured this. The only evidence is four case reports describing one patient each, which cannot give an overall rate or say who is most at risk.
What are the warning signs I should watch for?
The case reports describe fever and blood pressure that did not improve with fluids as signs of serious illness, but no study has tested which early symptoms predict this outcome in general.
Should I go to the emergency room if my pilonidal cyst looks infected?
The reported patients became seriously unwell quickly, so severe pain, spreading redness, fever, chills, or feeling faint around a pilonidal cyst should be checked urgently. In these reports, prompt drainage and antibiotics came before recovery.
Can a pilonidal cyst infection be fatal?
The four case reports describe patients who recovered after treatment; none describe a death. Case reports are often published because the outcome was notable, so this cannot tell us the true chance of death from an untreated severe infection.

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.

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