Title: Spontaneous Pubic Symphysis Osteomyelitis: A Case Report

Author(s): Kolin Korth, DO; Raymond Vaio, DO; Michael Ayad, MS

Email: KKorth@mercy.com

Introduction: Acute pubic symphysis osteomyelitis is a rare clinical condition, often occurring in patients with a history pelvic or genitourinary surgery. Clinically, it can be difficult to assess as patients may present with vague hip or groin pain, pubic tenderness, and inability or difficulty with ambulation.  Patients often have systemic symptoms including fever, leukocytosis, and bacteremia.

Case Report(s): We present a case of a 55-year-old male who presented with hip and groin pain occurring for approximately 10 weeks. Patient was having difficulty ambulating and had new onset pain radiating into his genitals. Patient had multiple CTs and MRIs demonstrating progressive erosive changes about the pubic symphysis. New MRI of the pelvis and left hip was ordered demonstrating abnormal fluid collection around the pubic symphysis. Interventional Radiology was consulted for aspiration of the abnormal fluid, with unsuccessful aspiration. The discission was made to proceed to the operating room for exploration, culture, and irrigation and debridement of the pubic symphysis. Patient was taken to the OR and careful dissection was taken down to the pubic symphysis where no fluid collection or purulence was observed. Cultures were obtained and the pubic symphysis was debrided of inflammatory tissues. Culture results were positive for Methicillin Resistant Staphylococcus Aureus.

Discussion: Spontaneous pubic symphysis osteomyelitis is a rare condition with a non-specific clinical exam. Patients may present with hip and groin pain, somewhat mimicking osseous hip pathology. Careful examination is needed for proper diagnosis and treatment for this condition. Bacterial organisms are a common source. The treatment of choice is adequate surgical debridement with implementation of antibiotics based on cultures obtained. Following treatment, our patients’ inflammatory markers normalized and his clinical symptoms improved.