Septic arthritis of the pubis symphysis: clinical and therapeutic features

Abstract

Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and therapeutic aspects of this disease. This is a retrospective study of 4 cases of septic arthritis of the pubic symphysis collected in the Department of Rheumatology and Orthopaedics in Sousse in Tunisia over a period of 16 years (2000-2016). Our population consists of 3 women and one men. The mean age was 47 years (18-83). Clinical signs of appeal were inflammatory groin pain, pubic pain and fever. Symptoms appeared after forceps delivery in 2 cases, after surgery on the pelvis in one case and in a context of sepsis in one case. Radiographs showed pubic disjunction with irregular shoreline in all cases. CT performed in all patients and MRI in 2 patients showed erosions of the banks of the pubic symphysis with infiltration of the soft parts in all cases. The causative organisms were isolated in 3 cases by biopsy of soft tissue abscess under CT in 2 cases and vaginal swab in one case. Identified germs were staphylococcus aureus Méti-S (n=1), proteus mirabilis (n=1) and varied flora (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in 2 cases. The outcome was favorable in all cases. Diagnosis of septic arthritis of the pubic symphysis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase.

Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients

“…If the image was suspicious of SAS, but only visualized on CT or PET/CT, an MRI was performed, as soft tissue changes are easily visualized early in the course of the disease (Alaya et al, 2017), whereas pelvic radiographs/CT are relatively insensitive as bone changes occur later in the disease process (Cardoso et al, 2017). Furthermore, MRI provides important information about the adjacent tissues to the symphysis and their associated pathologies like abscess and edema.…”

“…Some patients with SAS respond well to long-term antibiotic treatment and should as such not be treated operatively; however, it is suggested that > 50 % require surgical debride-ment (Ross and Hu, 2003). In cases with acute SAS (symptoms < 1 month) (Andole et al, 2011;Cardoso et al, 2017;el Mezouar et al, 2014;Alaya et al, 2017), systemic antibiotic should be considered as bone vascularity may not have been compromised and biofilm formation may not yet have developed (Zimmerli and Sendi, 2017). All of our patients had a diagnostic delay between 1 and 12 months, in which some had received antibiotics at their local hospital or referring department without infection control; thus they not considered acutely infected.…”

“…Some mistake the symptoms as osteitis pubis, a noninfectious inflammatory condition affecting the pubic symphysis, previously described in patients undergoing urologic procedures, following trauma, in pregnancies and in athletes with groin pain (Gomella and Mufarrij, 2017). The diagnosis of SAS is commonly missed or delayed due to the infrequency of the disease and its variable presentation, resulting in patients repeatedly being bounced between specialties before correct diagnosis (Alaya et al, 2017). This may lead to an unintended subtle progression of the infection making the treatment more difficult.…”

Relapsed Symptoms in a Patient Treated for Pubic Symphysis Septic Arthritis/Adjacent Osteomyelitis: Diagnostic Challenges

“…Septic arthritis of the pubic symphysis with adjacent osteomyelitis is rare and accounts for less than 1% of all anatomical sites with reported osteomyelitis [ 1 , 2 ]. Presenting symptoms include fever, pubic/groin pain, and antalgic gait.…”