Pubic Symphysis Septic Arthritis Caused by Pasteurella multocida

Abstract

Abstract Pubic symphysis septic arthritis is rare. To our knowledge, pubic symphysis septic arthritis caused by Pasteurella multocida has not been previously reported. A 79-year-old woman presented to the emergency department with a 3-day history of progressively severe left groin pain and swelling with unintentional 20-lb weight loss. Physical examination was negative except for the presence of a tender, fluctuant mass approximately 6 × 2-cm dimensions extending from the midpubic symphysis area to the left femoral crease. Computed tomography scan of the abdomen/pelvis confirmed a multiloculated mass in the area of the pubic symphysis measuring 7.6 × 2.1 × 5.5 cm with fluid extending posteriorly behind the pubic symphysis and erosion of bone in the pubic symphysis. Ultrasound-guided aspiration of the mass yielded 6 mL of purulent fluid with many Gram-negative bacilli on Gram-stained smear and a pure growth P. multocida on culture. Intravenous piperacillin/tazobactam was begun. The patient underwent operative drainage of the mass, and operative cultures revealed pure growth of P. multocida. Subsequently obtained history revealed that the patient has 1 pet cat with only 1 remaining tooth and the patient has not been bitten, scratched, or licked by the cat. Patient was treated with parenteral piperacillin/tazobactam and then ampicillin/sulbactam followed by oral amoxicillin/clavulanate. She rapidly returned to normal activities with no recurrence at 3 months' follow-up.