Infect Chemother.  2009 Jun;41(3):185-189. 10.3947/ic.2009.41.3.185.

Experience of Osteomyelitis of the Pubic Symphysis Following Surgical Treatment of Perianal Necrotizing Fasciitis

• Kim JY
• Kim TH
• Choo EJ
• Jeon MH
• Lee EJ
• Kim JH
• Park EJ
• Lee JC
• Jin SY

• KMID: 1782322
• DOI: http://doi.org/10.3947/ic.2009.41.3.185

Abstract

Osteomyelitis of the pubic symphysis is not common and has often been reported to occur after urological or gynecological procedures. It can be spontaneous in origin but it also is associated with trauma, athletic exertion, pregnancy, and parturition. The early symptoms of osteomyelitis of the pubic symphysis mimic those of osteitis pubis, and therefore, the differential diagnosis between these two entities is of clinical importance. A fifty nine-year-old man who had previously received debridement and wide excision of perianal necrotizing fasciitis visited our hospital with pain on both inguinal areas. The core biopsy of the pubic symphysis and aspiration culture were performed, from which Pseudomonas aeruginosa was recovered. He was treated with parenteral ceftazidime for 5 days followed by cefepime for 7 weeks and showed favorable clinical response. To our knowledge, this is the first report on osteomyelitis of pubic symphysis resulting from debridement and wide excision of perianal necrotizing fasciitis in Korea.

Keyword

Osteomyelitis; Pubic symphysis; Fasciitis; Pseudomonas aeruginosa

MeSH Terms

Biopsy
Ceftazidime
Cephalosporins
Debridement
Diagnosis, Differential
Fasciitis
Fasciitis, Necrotizing
Hydrazines
Korea
Osteitis
Osteomyelitis
Parturition
Pregnancy
Pseudomonas aeruginosa
Pubic Symphysis
Sports
Ceftazidime
Cephalosporins
Hydrazines

Figure

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  Figure 1 Plain radiograph of the pelvis shows slight widening of pubic symphysis with marginal bony destruction, which is more marked on the left side of the pubis.

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  Figure 2 A) T1-weighted MRI of the pelvis shows decreased signal within medial aspects of both pubic bones, adductor muscle, and around soft tissue, B) T2-weighted transverse MRI of the pelvis shows increased signal within medical aspects of both pubic bones, adductor muscle, and around soft tissue, C) gadolinium enhanced T1-weighted MRI of the pelvis shows decreased signal within central area with peripheral enhancement.

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  Figure 3 A) Core needle biopsy of the pubic symphysis demonstrates acute pyogenic osteomyelitis in the bone (H-E, ×100) and B) fine needle aspiration cytology from the surrounding soft tissue discloses a few anucleated squames admixed with innumerable acute inflammatory cells (H-E, ×200).

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