Osteomyelitis pubis: a rare and elusive diagnosis

Abstract

Osteomyelitis pubis is an infectious inflammation of the symphysis pubis and accounts for 2% of hematogenous osteomyelitis. This differs from osteitis pubis, a non-infectious inflammation of the pubic symphysis, generally caused by shear forces in young athletes. Both conditions present with similar symptoms and are usually differentiated on the basis of biopsy and/or culture. A case of osteomyelitis pubis is presented with a discussion of symphisis pubis anatomy, clinical and laboratory presentation, etiology and risk factors, and optimal imaging studies.

Figure

Axial T2 weighted image of the pelvis with fat saturation reveals bone marrow edema (white) on the right ischial spine just adjacent to the symphysis pubis suggesting osteomyelitis. Blood cultures grew Methicillin-sensitive Staphylococcus aureus and patient was treated with a prolonged course of intravenous ceftriaxone by the inpatient infectious disease team and improved.