Tuberculosis of the pubic symphysis

Abstract

Tuberculosis is one of India's public health problems. It involves various systems of the body, including the skeletal system. Osteoarticular tuberculosis is the second most common form of extrapulmonary tuberculosis next to lymph nodes and constitutes about 13% of all extrapulmonary cases. It is generally accepted that osteoarticular tuberculosis is the result of a haematogenous or lymphatic spread from a reactivated latent focus, usually pulmonary; however, previous infection is not always encountered, and in only 40-50% of the cases, it is possible to demonstrate another active infection site. The commonest site for skeletal tuberculosis is the spine followed by the hip, knee and ankle joints. Tuberculosis can involve literally any bone or joint. Pubic symphysis is an uncommon site for tuberculosis in the case of the skeletal system. We present a rare case of pubic symphysis tuberculosis in a 25-year-old woman presented to the general surgical department with a swelling in the right thigh region.

Report of a Rare Case of Pubic Symphysis Tuberculosis in an Eight-Year-Old Child: An Unusual Presentation of the Disease

“…Patients typically seek medical attention when they develop an abscess (as in our case) in the community of the symphysis, medial side of the thigh, or anal area [ 13 ]. These abscesses can lead to sinus or fistula formation, cold abscess, or hypogastric mass, causing significant morbidity and mortality [ 2 ].…”

“…Differential diagnoses in such cases may include osteomyelitis, osteitis pubis, and adolescent osteochondritis of the symphysis pubis [ 14 ]. Osteitis pubis is a non-infectious, self-limiting inflammation of the pubic symphysis commonly seen in athletes during pregnancy, after gynecological and urological surgeries, or after trauma to the pubic symphysis [ 2 ]. Unlike tuberculosis of the pubis, osteitis pubis is characterized by severe discomfort over the pubic symphysis without any evidence of abscess formation.…”

“…The presence of elevated fluid adenosine deaminase levels may aid in the diagnosis of tuberculosis. In cases where surgery is required, it is typically to discharge large abscesses or retrieve tissue samples, and bone grafting should be avoided on an infected bed [ 2 ].…”

“…However, in the pre-chemotherapy era, up to 100 cases were reported in the early 20th century, all of which were diagnosed in advanced stages. The first case of pubic symphysis tuberculosis in the literature was published by Jackson in 1923 [ 2 ].…”