Pubic symphysis septic arthritis and osteomyelitis

Case contributed by Assoc Prof Craig Hacking

Presentation

Diabetic with foot ulcer. Now anterior pelvic pain for 2 weeks.

Patient Data

Age: 65 years
Gender: Female

Widening of the pubic symphysis with mildly sclerotic and mottled articular cortices and subtle subarticular lucency suggestive of infection. Degenerative SI joins. Surgical clips noted on the right. Vascular calcification.

Biopsy showed features of chronic osteomyelitis and culture grew Pseudomonas. MRI (iamges not available) confirmed septic arthritis of the symphysis and a small sinus extending into the left groin.

The patient received long term IV antibitoics but failed to improve. 3 months later, orthopedics performed a surgical debridement and placed antibiotic beads into the symphysis.

Persistent widening of the pubic symphysis. Dense material in the symphysis in keeping with antibiotic beads. Surgical drain noted.

Case Discussion

The pubic symphysis is an uncommon site for septic arthritis and osteomyelitis and is usually seen in patients that are immunocompromised.

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