Septic arthritis of the pubic symphysis fromPseudomonas aeruginosa: reconsidering traditional risk factors and symptoms in the elderly patient

Abstract

SummaryA high-functioning 82-year-old man presented with lower lumbar pain and pubic tenderness. On admission he was afebrile with a normal white count. A grossly elevated C reactive protein was noted. CT scan of the pelvis showed a fluid collection anterior to the pubic symphysis and to the right of the midline measuring 2.0 × 2.2 cm. Pseudomonas aeruginosa was cultured from the fluid collection. The patient had no history of intravenous drug use, pelvic surgeries, malignancies or trauma. We report what we believe is the first documented case of P aeruginosa infection of the pubic symphysis in an elderly patient that did not have any of the traditional risk factors associated with neither P aeruginosa septic arthritis nor infections of the pubic symphysis. Instead, we propose that phimosis with chronic infection of the foreskin and balanitis may have led to septic arthritis. BACKGROUND

Septic arthritis of the pubis symphysis: clinical and therapeutic features

“…It is usually associated with pelvic surgery, pelvic malignancies, pregnancy, intravenous drug use and recent athletic activity [1,2,5-9]. This disease is not specific to any age group and can range from 7 to 86 years of age [7].…”

“…Septic arthritis of the pubic symphysis, so called osteomyelitis pubis is the infection which involves pubic symphysis and its joint [ 1 ]. It is usually associated with pelvic surgery, pelvic malignancies, pregnancy, intravenous drug use and recent athletic activity [ 1 , 2 , 5 - 9 ]. This disease is not specific to any age group and can range from 7 to 86 years of age [ 7 ].…”

“…Despite MRI being the most sensitive imaging test, only aspiration (ie, microorganism isolation) provides the ultimate proof of the presence of infection [ 4 ]. CT scan of the pelvis showed mild widening and erosive changes involving the pubic symphyis associated to fluid collection [ 5 ]. Microbiology cultures from an ultrasound or scan guided aspiration of the fluid collection reveals the germ [ 5 ].…”

“…CT scan of the pelvis showed mild widening and erosive changes involving the pubic symphyis associated to fluid collection [ 5 ]. Microbiology cultures from an ultrasound or scan guided aspiration of the fluid collection reveals the germ [ 5 ].…”

“…It should be suspected in patients with inflammatory groin pain, pubic pain and fever [ 1 , 2 , 4 ]. It is frequently associated with prior gynaecological/urological surgery or pelvic malignancy [ 1 , 5 ]. Radiographic signs can be delayed or undetected in certain modalities of radiological investigation.…”