Table 1 Documented cases reports of osteomyelitis of the pubic symphysis in peri/post-partum
Reference | Age | Parity | Type of delivery | Clinical features | Radiological finding | Pathogen | Treatment | Outcomes |
|---|---|---|---|---|---|---|---|---|
Eskridge et al. [5] | 33 years | 1 | Vaginal delivery with shoulder dystocia required episiotomy, suprapubic pressure and McRobert’s maneuver | Pubic pain with ambulation starting 1 day after delivery; fever; leukocytosis | Diastasis of the symphysis pubis, erosion of pubic rami, vulvar edema | Staphylococcus epidermidis Enterococcus faecalis | Intravenous (IV) ampicillin, sulbactam sodium changed to cefazolin and metronidazole Surgical debridemen | Complete recovery |
Lovisetti et al. [6] | 25 years | 2 | Normal vaginaldelivery | Pubic pain starting 1 day after delivery; fever; ↑ erythrocyte sedimentation rate (ESR), leukocytosis | Diastasis of the symphysis \pubis, bone rarefaction, suprapubic abscess | Staphylococcus aureus | IV Mezlocillin, netilmicin Surgical debridement Stabilisation of the symphysis with a Hoffmann external frame | Complete recovery |
Gamble et al. [7] | 37 years | 1 | Cesarean section | Pubic pain with ambulation starting at 28 weeks of gestation; erythema and edema over the labia, mons pubis, and lower abdomen; low grade fever; normal complete blood count | Diastasis of the symphysis pubis, enhancing mass with a high T1 signal suggesting superinfected hematoma or abscess | Staphylococcus aureus Pseudomonas aeuroginosa Serratia marcescens | IV vancomycin, levofloxacin, metronidazole Surgical debridement | Complete recovery |
Ikpeme et al. [8] | 28 years | Not reported | Normal vaginal delivery | Pubic pain starting 8 weeks after delivery; low grade fever; ↑ ESR, normal complete blood count | Diastasis of the symphysis pubis, irregular erosion, lytic lesions | Pseudomonas aeuroginosa | Antibiotics (not specified) Surgical debridement | Complete recovery |
Dunk et al. [9] | 43 years | Not reported | Normal vaginal delivery | Pubic and groin pain starting 5 days after delivery, low grade fever, leukocytosis, ↑ C-protein reactive (CPR) | Reactive sclerosis, rarefaction, osteolysis and joint irregularity | Streptococcus group G | IV cefuroxime, metronidazole Surgical debridement | Complete recovery |
31 years | Not reported | Normal vaginal delivery | Pubic pain starting 12 h after delivery, fever, leukocytosis, ↑ CPR | Reactive sclerosis, rarefaction, osteolysis and joint irregularity | Staphylococcus epidermidis | IV cefuroxime | Complete recovery | |
Lawford et al. [10] | 27 years | 1 | Emergency cesarean section for fetal tachycardia with decreased variability and late decelerations to the cardiotocography | Groin pain, tenderness to palpation in the right iliac fossa with signs of peritonism, marked vulvar oedema and fever starting at 37 weeks of gestation; normal complete blood count, ↑ CPR | 5 cm collection surrounding the symphysis pubis with extension into the soft tissues | Staphylococcus aureus | IV ceftriaxone, metronidazole and gentamicin changed to flucloxacillin and cephazolin based on antibiogram results | Complete recovery |
Froberg et al. [11] | 33 years | Not reported | Normal vaginal delivery | Pubic pain starting at 12 weeks of gestation; normal complete blood count | Fluid within the symphysis, bilateral oedema of the pubic rami and bony erosions. | Staphylococcus capitis Cutibacterium acnes | IV clindamycin | Complete recovery |
Current case report | 39 years | 3 | Normal vaginal delivery | Pubic pain starting 12 hours after the delivery; fever, leukocytosis, ↑ CPR, ↑ procalcitonin | Diastasis of the symphysis pubis, tiny irregularities of articular surfaces, pseudo-capsulated fluid collection within the symphysis, joint effusion | Methicillin-resistant Staphylococcus aureus | IV piperacillin-tazobactam changed to vancomycin and levofloxacin based on antibiogram, then after 2 weeks, oral combination of levofloxacin plus rifampicin. | Complete recovery |