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Table 1 Documented cases reports of osteomyelitis of the pubic symphysis in peri/post-partum

From: Osteomyelitis of the pubic symphysis caused by methicillin-resistant Staphylococcus aureus after vaginal delivery: a case report and literature review

ReferenceAgeParityType of deliveryClinical featuresRadiological findingPathogenTreatmentOutcomes
Eskridge et al. [5]33 years1Vaginal delivery with shoulder dystocia required episiotomy, suprapubic pressure and McRobert’s maneuverPubic pain with ambulation starting 1 day after delivery; fever; leukocytosisDiastasis of the symphysis pubis, erosion of pubic rami, vulvar edemaStaphylococcus epidermidis
Enterococcus faecalis
Intravenous (IV) ampicillin, sulbactam sodium changed to cefazolin and metronidazole
Surgical debridemen
Complete recovery
Lovisetti et al. [6]25 years2Normal vaginaldeliveryPubic pain starting 1 day after delivery; fever; ↑ erythrocyte sedimentation rate (ESR), leukocytosisDiastasis of the symphysis \pubis, bone rarefaction, suprapubic abscessStaphylococcus aureusIV Mezlocillin, netilmicin
Surgical debridement
Stabilisation of the symphysis with a Hoffmann external frame
Complete recovery
Gamble et al. [7]37 years1Cesarean sectionPubic 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 countDiastasis of the symphysis pubis, enhancing mass with a high T1 signal suggesting superinfected hematoma or abscessStaphylococcus aureus
Pseudomonas aeuroginosa
Serratia marcescens
IV vancomycin, levofloxacin, metronidazole
Surgical debridement
Complete recovery
Ikpeme et al. [8]28 yearsNot reportedNormal vaginal deliveryPubic pain starting 8 weeks after delivery; low grade fever; ↑ ESR, normal complete blood countDiastasis of the symphysis pubis, irregular erosion, lytic lesionsPseudomonas aeuroginosaAntibiotics (not specified)
Surgical debridement
Complete recovery
Dunk et al. [9]43 yearsNot reportedNormal vaginal deliveryPubic and groin pain starting 5 days after delivery, low grade fever, leukocytosis, ↑ C-protein reactive (CPR)Reactive sclerosis, rarefaction, osteolysis and joint irregularityStreptococcus group GIV cefuroxime, metronidazole
Surgical debridement
Complete recovery
31 yearsNot reportedNormal vaginal deliveryPubic pain starting 12 h after delivery, fever, leukocytosis, ↑ CPRReactive sclerosis, rarefaction, osteolysis and joint irregularityStaphylococcus epidermidisIV cefuroximeComplete recovery
Lawford et al. [10]27 years1Emergency cesarean section for fetal tachycardia with decreased variability and late decelerations to the cardiotocographyGroin 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, ↑ CPR5 cm collection surrounding the symphysis pubis with extension into the soft tissuesStaphylococcus aureusIV ceftriaxone, metronidazole and gentamicin changed to flucloxacillin and cephazolin based on antibiogram resultsComplete recovery
Froberg et al. [11]33 yearsNot reportedNormal vaginal deliveryPubic pain starting at 12 weeks of gestation; normal complete blood countFluid within the symphysis, bilateral oedema of the pubic rami and bony erosions.Staphylococcus capitis Cutibacterium acnesIV clindamycinComplete recovery
Current case report39 years3Normal vaginal deliveryPubic pain starting 12 hours after the delivery; fever, leukocytosis, ↑ CPR, ↑ procalcitoninDiastasis of the symphysis pubis, tiny irregularities of articular surfaces, pseudo-capsulated fluid collection within the symphysis, joint effusionMethicillin-resistant Staphylococcus aureusIV piperacillin-tazobactam changed to vancomycin and levofloxacin based on antibiogram, then after 2 weeks, oral combination of levofloxacin plus rifampicin.Complete recovery