Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis

Report of four cases and review

Daniel J. Sexton, Linda Heskestad, William R. Lambeth, Rex McCallum, L. Scott Levin, G. Ralph Corey

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)695-700
Number of pages6
JournalClinical Infectious Diseases
Volume17
Issue number4
StatePublished - Oct 1993
Externally publishedYes

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Pubic Bone
Osteitis
Osteomyelitis
Diagnostic Errors
Needle Biopsy
Biopsy
Pelvic Pain
Natural History
Gait
Fever

ASJC Scopus subject areas

  • Immunology

Cite this

Sexton, D. J., Heskestad, L., Lambeth, W. R., McCallum, R., Levin, L. S., & Corey, G. R. (1993). Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: Report of four cases and review. Clinical Infectious Diseases, 17(4), 695-700.

Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis : Report of four cases and review. / Sexton, Daniel J.; Heskestad, Linda; Lambeth, William R.; McCallum, Rex; Levin, L. Scott; Corey, G. Ralph.

In: Clinical Infectious Diseases, Vol. 17, No. 4, 10.1993, p. 695-700.

Research output: Contribution to journalArticle

Sexton, DJ, Heskestad, L, Lambeth, WR, McCallum, R, Levin, LS & Corey, GR 1993, 'Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: Report of four cases and review', Clinical Infectious Diseases, vol. 17, no. 4, pp. 695-700.
Sexton, Daniel J. ; Heskestad, Linda ; Lambeth, William R. ; McCallum, Rex ; Levin, L. Scott ; Corey, G. Ralph. / Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis : Report of four cases and review. In: Clinical Infectious Diseases. 1993 ; Vol. 17, No. 4. pp. 695-700.
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