{ "slug": "can-a-pilonidal-cyst-cause-sepsis", "question": "Can a pilonidal cyst cause sepsis?", "shortTitle": "Pilonidal Cyst and Sepsis Risk", "clinicalQuestion": "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?", "questionKind": "cause-risk", "pico": { "population": "People with a pilonidal cyst, sinus, or abscess", "intervention": "Presence of an infected or untreated pilonidal cyst/sinus", "comparator": "People without pilonidal disease, or pilonidal disease that is treated promptly", "outcomes": [ "Incidence of sepsis or septic shock", "Bacteremia or positive blood cultures", "Hospital admission for systemic infection", "ICU admission", "Sepsis-related mortality", "Time from symptom onset to systemic infection" ], "excludes": [] }, "category": "anorectal", "relatedConditions": [ "pilonidal-cyst", "sepsis", "skin-abscess" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "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.", "detail": "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.", "studyIds": [ "pmid:29437816", "pmid:17661075", "pmid:9369118" ] }, "strength": { "level": "very-low", "why": "The only direct evidence is 3 small or uncontrolled studies.", "override": null }, "direction": { "level": "probable-benefit", "why": "The evidence points to a benefit, but it is not strong enough to be confident.", "override": null, "signOff": null, "withheld": null }, "counts": { "recordsRetrieved": 19, "recordsScreened": 19, "included": 4, "rcts": 0, "systematicReviews": 0, "observational": 0, "participants": 13, "yearFrom": 1997, "yearTo": 2018, "registeredTrialsWithoutResults": 0, "direct": 3 }, "excluded": [], "outcomes": [ { "name": "Incidence of sepsis or septic shock", "status": "not-studied", "note": "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.", "studyIds": [ "pmid:29437816", "pmid:9369118" ] }, { "name": "Bacteremia or positive blood cultures", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:29437816" ] }, { "name": "Hospital admission for systemic infection", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:29437816", "pmid:17661075", "pmid:9369118" ] }, { "name": "ICU admission", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:29437816", "pmid:9369118" ] }, { "name": "Sepsis-related mortality", "status": "not-studied", "note": "The patients in these case reports survived. No study has measured how often severe infection from a pilonidal cyst is fatal.", "studyIds": [ "pmid:29437816", "pmid:17661075", "pmid:9369118" ] }, { "name": "Time from symptom onset to systemic infection", "status": "not-studied", "note": "No study measured how long it takes for a pilonidal cyst to progress to a severe, body-wide infection.", "studyIds": [ "pmid:29437816", "pmid:17661075", "pmid:9369118" ] } ], "benefits": [ { "text": "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).", "studyIds": [ "pmid:29437816", "pmid:17661075", "pmid:9369118" ] } ], "limitations": [ { "text": "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.", "studyIds": [ "pmid:29437816", "pmid:17661075", "pmid:9369118" ] }, { "text": "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.", "studyIds": [ "pmid:17319435" ] }, { "text": "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.", "studyIds": [ "pmid:29437816", "pmid:17661075", "pmid:9369118" ] } ], "risks": [ { "text": "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.", "studyIds": [ "pmid:29437816" ], "severity": "serious" }, { "text": "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.", "studyIds": [ "pmid:9369118" ], "severity": "serious" }, { "text": "A severe muscle infection (pyomyositis) caused by a toxin-producing staph bacteria has been reported as a complication of a pilonidal cyst.", "studyIds": [ "pmid:17661075" ], "severity": "serious" } ], "whyPeopleTryIt": [ { "text": "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." }, { "text": "Stories online or from other patients about pilonidal infections becoming severe can raise fear, even though such outcomes are rarely described in medical literature." }, { "text": "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." } ], "keyStudies": [ "pmid:29437816", "pmid:9369118", "pmid:17661075", "pmid:17319435" ], "studies": [ { "id": "pmid:29437816", "pmid": "29437816", "doi": "10.1136/bcr-2017-223497", "nctId": null, "pmcid": "PMC5836690", "title": "Teenage boy with high fever and rash: what could we be missing?", "firstAuthor": "Oliveira", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2018, "design": "case-series", "n": 1, "nField": "reported", "population": "15-year-old boy with high fever and rash", "intervention": "no treatment intervention studied (case report of pilonidal abscess causing illness)", "comparator": "none", "primaryOutcome": "development of severe infection (sepsis/shock) from pilonidal abscess", "result": "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", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how often this happens or prove cause and effect.", "directness": "direct", "relevanceNote": "", "limitations": "Single case report with no comparison group; cannot establish how common this complication is.", "followUp": "4 days", "plainFinding": "Pilonidal abscess caused severe shock.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29437816/", "sourceText": "A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat. He was started on intravenous flucloxacillin and 12 hours later develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine. Intravenous clindamycin was added and transportation to paediatric intensive care unit arranged. Dopamine dosing was increased and norepinephrine infusion was added subsequently with immediate stabilisation of DBP. 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. This case report summarises a potential severe complication of the pilonidal disease.", "provenance": [ { "field": "n", "quote": "A 15-year-old boy was admitted" }, { "field": "population", "quote": "A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat." }, { "field": "intervention", "quote": "A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage." }, { "field": "comparator", "quote": "This case report summarises a potential severe complication of the pilonidal disease." }, { "field": "primaryOutcome", "quote": "develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:17661075", "pmid": "17661075", "doi": "10.1007/s00423-007-0212-3", "nctId": null, "pmcid": null, "title": "Severe pyomyositis caused by Panton-Valentine leucocidin-positive methicillin-sensitive Staphylococcus aureus complicating a pilonidal cyst", "firstAuthor": "Lorenz", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2007, "design": "case-series", "n": 1, "nField": "reported", "population": "23-year-old healthy man with an operated pilonidal cyst", "intervention": "aggressive antibiotic and surgical treatment plus immunoglobulins", "comparator": "none", "primaryOutcome": "recovery from severe muscle infection (pyomyositis)", "result": "patient recovered without relapse after intensive treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how often this happens or prove cause and effect", "directness": "direct", "relevanceNote": "", "limitations": "only one patient described, no comparison group, specific rare bacterial toxin involved", "followUp": "not specified beyond 'in the follow-up' and 'without relapse'", "plainFinding": "Pilonidal cyst led to severe muscle infection, sepsis risk", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17661075/", "sourceText": "BACKGROUND: To our best knowledge, Panton-Valentine leucocidin (PVL)-positive methicillin-sensitive Staphylococcus aureus (MSSA) has not been described yet as cause for severe pyomyositis. CASE REPORT: We present a 23-year-old apparently healthy male patient without any typical predisposing findings who developed severe pyomyositis secondary to an operated pilonidal cyst. In the follow-up, the patient showed signs of immunocompromisation. The causative agent for purulent infection of multiple muscles was a MSSA strain harbouring PVL toxin. RESULTS: In the reported case, aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead to recovery from the disease without relapse. CONCLUSIONS: PVL-positive S. aureus are associated with skin diseases, multiple abscesses and often complicated by severe sepsis and necrotising pneumonia. Under such circumstances, the mortality rate can reach up to 75%. In addition, the PVL toxin can cause immunocompromisation and might be therefore involved in the aetiology of pyomyositis. Aggressive antibiotic and surgical treatment with additional application of immunoglobulins is recommended for treatment.", "provenance": [ { "field": "n", "quote": "a 23-year-old apparently healthy male patient" }, { "field": "population", "quote": "a 23-year-old apparently healthy male patient without any typical predisposing findings who developed severe pyomyositis secondary to an operated pilonidal cyst" }, { "field": "intervention", "quote": "aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead to recovery from the disease without relapse" }, { "field": "comparator", "quote": "CASE REPORT" }, { "field": "primaryOutcome", "quote": "recovery from the disease without relapse" }, { "field": "result", "quote": "aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead to recovery from the disease without relapse" } ] }, { "id": "pmid:17319435", "pmid": "17319435", "doi": null, "nctId": null, "pmcid": null, "title": "[Infectious spondylodiskitis and epidural abscess after spinal puncture for pilonidal sinus excision]", "firstAuthor": "Pavón Benito", "multipleAuthors": true, "journal": "Rev Esp Anestesiol Reanim", "year": 2007, "design": "narrative-review", "n": 10, "nField": "reported", "population": "patients who developed vertebral infections after spinal puncture performed during pilonidal sinus excision surgery", "intervention": "spinal puncture used for anesthesia during surgery", "comparator": "spontaneous epidural abscess occurrence (not related to puncture)", "primaryOutcome": "development of vertebral or epidural infection after spinal puncture", "result": "the incidence of these infections after puncture does not exceed that of spontaneous epidural abscesses, so a causal link to the puncture is uncertain", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "relevanceNote": "", "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.", "followUp": "", "plainFinding": "Rare spine infection after spinal puncture", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17319435/", "sourceText": "Vertebral infections after spinal puncture are rare and often inadequately documented. 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. After analyzing 10 published cases we saw that only half of them reported on aseptic conditions and only 2 patients seem to have had a prior infection. In 3 cases, the abscesses appeared after technically simple punctures whereas half the reports did not even mention the type of puncture. This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established.", "provenance": [ { "field": "n", "quote": "After analyzing 10 published cases" }, { "field": "population", "quote": "Vertebral infections after spinal puncture are rare and often inadequately documented." }, { "field": "intervention", "quote": "spinal puncture" }, { "field": "comparator", "quote": "Their incidence does not exceed that of spontaneous epidural abscesses" }, { "field": "primaryOutcome", "quote": "Vertebral infections after spinal puncture are rare and often inadequately documented." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:9369118", "pmid": "9369118", "doi": "10.1007/BF02050828", "nctId": null, "pmcid": null, "title": "Toxic shock syndrome and necrotizing fasciitis complicating neglected sacrococcygeal pilonidal sinus disease: report of a case", "firstAuthor": "Velitchkov", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 1997, "design": "case-series", "n": 1, "nField": "reported", "population": "an adult man with neglected pilonidal sinus disease at the base of the spine", "intervention": "emergency surgery with repeated removal of dead tissue, fluids, antibiotics, and hyperbaric oxygen treatment", "comparator": "none", "primaryOutcome": "survival and recovery from severe infection (necrotizing fasciitis and toxic shock syndrome)", "result": "the patient recovered well after aggressive combined treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how often this happens or what causes it.", "directness": "direct", "relevanceNote": "", "limitations": "only one patient described, no comparison group, treatment response may not generalize", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9369118/", "sourceText": "PURPOSE: This study was conducted to report the rare combination of necrotizing fasciitis and toxic shock syndrome, which both complicated neglected sacrococcygeal pilonidal sinus disease. METHODS: A case report is presented. RESULTS: We describe the rare case of a previously healthy adult male patient who developed necrotizing fasciitis and toxic shock syndrome associated with Streptococcus pyogenes and Bacteroides fragilis. 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. CONCLUSION: This case serves again as a clear reminder that neglected pilonidal sinus disease can lead to unusual and life-threatening consequences.", "provenance": [ { "field": "population", "quote": "a previously healthy adult male patient who developed necrotizing fasciitis and toxic shock syndrome associated with Streptococcus pyogenes and Bacteroides fragilis" }, { "field": "intervention", "quote": "emergency surgery followed by repeated debridements of necrotic tissue, together with aggressive fluid resuscitation, broad-spectrum antibiotic coverage, and hyperbaric oxygenation" }, { "field": "comparator", "quote": "A case report is presented." }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "We describe the rare case of a previously healthy adult male patient" } ] } ], "faqs": [ { "q": "Can a pilonidal cyst cause sepsis?", "a": "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." }, { "q": "How common is sepsis from a pilonidal cyst?", "a": "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." }, { "q": "What are the warning signs I should watch for?", "a": "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." }, { "q": "Should I go to the emergency room if my pilonidal cyst looks infected?", "a": "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." }, { "q": "Can a pilonidal cyst infection be fatal?", "a": "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." } ], "searchedAs": [ "can a pilonidal cyst cause sepsis" ], "patientTakeaway": "A pilonidal cyst turning into a life-threatening, body-wide infection appears to be rare, but it has happened, and in the reported cases it got worse quickly. If the area becomes very red, swollen, hot, or very painful, or you develop fever, chills, a fast heartbeat, or feel faint, get urgent medical care rather than waiting it out at home.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "\"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])" }, "pubmedQueryTranslation": "\"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])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Can a pilonidal cyst cause sepsis?", "description": "Research on whether pilonidal cysts can cause sepsis: 4 case reports describe severe infections, but true incidence is unknown." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13", "gradeRules": "ev-1" }, "status": "published" }