Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four cases and review.

Published

Journal Article

Osteitis pubis is a painful inflammatory process resulting in bony destruction of the margins of the symphysis pubis. Despite six decades of speculation, the pathogenesis of, criteria for diagnosis of, natural history of, and optimal therapy for osteitis pubis remain controversial. We present four cases of postoperative pubic osteomyelitis that were initially thought to be typical cases of osteitis pubis. These cases illustrate that pubic osteomyelitis can mimic the principal features of osteitis pubis including characteristic pelvic pain and gait disturbance, symmetrical bony destruction of the symphysis pubis, absence of fever, a long interval between surgery and onset of symptoms, lack of response to antimicrobial therapy, and apparent spontaneous cure. We believe that many previously reported cases of osteitis pubis were actually cases of unrecognized pubic osteomyelitis. We advise an aggressive diagnostic approach to cases of apparent postoperative osteitis pubis including biopsy and needle aspiration of the symphysis pubis guided by computer-assisted tomography. If cultures of biopsy specimens are not diagnostic, open biopsy of the symphysis pubis is recommended.

Full Text

Duke Authors

Cited Authors

  • Sexton, DJ; Heskestad, L; Lambeth, WR; McCallum, R; Levin, LS; Corey, GR

Published Date

  • October 1993

Published In

Volume / Issue

  • 17 / 4

Start / End Page

  • 695 - 700

PubMed ID

  • 8268352

Pubmed Central ID

  • 8268352

International Standard Serial Number (ISSN)

  • 1058-4838

Digital Object Identifier (DOI)

  • 10.1093/clinids/17.4.695

Language

  • eng

Conference Location

  • United States