188. Pubic symphysis osteomyelitis: A case report

Abstract

Introduction Pubic symphysis osteomyelitis following vaginal delivery is a rare and painful infection involving the symphysis and parasymphyseal parts of the pubic bones. #_ftn1 It accounts for 2% of haematogenous osteomyelitis. #_ftn2 Pubic symphysis osteomyelitis usually presents with pubic and generalized pelvic pain and low-grade fever, and may be associated with pelvic instability and a waddling gate. Case A 34 year old woman was brought in by ambulance after the very sudden onset of excruciating pubic pain four days postnatally following a vaginal delivery, where forceps extraction was required. She later developed pyrexia with a temperature of 38.4 degrees, elevated inflammatory markers (CRP 65.5 mg/L, white cell count 13.84 109/L). Blood cultures revealed a persistent Staphylococcus aureus bacteraemia, for which no other source was identified. She underwent CT of her abdomen and pelvis, and was treated with a prolonged course of intravenous then oral antibiotics. Discussion This condition is described infrequently in pregnancy #_ftn3–#_ftn4. The main differential diagnosis is osteitis pubis, a non-infectious inflammatory disorder of the symphysis pubis that usually occurs following shearing trauma of pelvis in young athletes but can occur after delivery. Furthermore, the diagnosis of pubic symphysis osteomyelitis can be challenging with other similarly presenting conditions involving the pelvis in postnatal women, such as postpartum endomyometritis, urinary infection, persistent pelvic girdle pain and diastasis of the pubic symphysis joint. The diagnosis of pubic symphysis osteomyelitis is usually made on clinical grounds supported by investigations including inflammatory markers, blood cultures and imaging findings supportive of pubic bone infection. A biopsy from the symphysis pubis and positive bacterial culture establishes a definitive diagnosis but this is not always required to make the diagnosis. Conservative treatment based on long term antibiotics is usually sufficient in most cases; however, failure to respond properly to antibiotics would require surgical debridement.