Postoperative Pubic Osteomyelitis Misdiagnosed as Osteitis Pubis: Report of Four Cases and Review
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 c...
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| Veröffentlicht in: | Clinical infectious diseases 1993-10, Vol.17 (4), p.695-700 |
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| creator | Sexton, Daniel J. Heskestad, Linda Lambeth, William R. McCallum, Rex Levin, L. Scott Corey, G. Ralph |
| description | 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. |
| doi_str_mv | 10.1093/clinids/17.4.695 |
| format | Article |
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Scott ; Corey, G. Ralph</creator><creatorcontrib>Sexton, Daniel J. ; Heskestad, Linda ; Lambeth, William R. ; McCallum, Rex ; Levin, L. Scott ; Corey, G. Ralph</creatorcontrib><description>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.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/clinids/17.4.695</identifier><identifier>PMID: 8268352</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Adult ; Anti-Bacterial Agents - therapeutic use ; Antimicrobials ; Bacterial arthritis and osteitis ; Bacterial diseases ; Biological and medical sciences ; Biopsies ; Bones ; Clinical Infectious Disease Articles ; Debridement ; Diagnostic Errors ; Female ; Human bacterial diseases ; Humans ; Infections ; Infectious diseases ; Magnetic Resonance Imaging ; Medical sciences ; Middle Aged ; Osteitis ; Osteitis - diagnosis ; Osteomyelitis ; Osteomyelitis - diagnosis ; Osteomyelitis - drug therapy ; Osteomyelitis - microbiology ; Postoperative Complications ; Pseudomonas Infections - diagnosis ; Pseudomonas Infections - drug therapy ; Pseudomonas Infections - microbiology ; Pubic symphysis ; Pubic Symphysis - diagnostic imaging ; Pubic Symphysis - pathology ; Radiography ; Staphylococcal Infections - diagnosis ; Staphylococcal Infections - drug therapy ; Staphylococcal Infections - microbiology ; Symptoms ; Tomography, X-Ray Computed ; Urinary Incontinence, Stress - surgery</subject><ispartof>Clinical infectious diseases, 1993-10, Vol.17 (4), p.695-700</ispartof><rights>Copyright 1993 The University of Chicago</rights><rights>1993 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c297t-fa7d0cfbdae29e5950051019e64031adac5086c94f6ab97559c63c9ec148b25c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/4457368$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/4457368$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4907734$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8268352$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sexton, Daniel J.</creatorcontrib><creatorcontrib>Heskestad, Linda</creatorcontrib><creatorcontrib>Lambeth, William R.</creatorcontrib><creatorcontrib>McCallum, Rex</creatorcontrib><creatorcontrib>Levin, L. Scott</creatorcontrib><creatorcontrib>Corey, G. Ralph</creatorcontrib><title>Postoperative Pubic Osteomyelitis Misdiagnosed as Osteitis Pubis: Report of Four Cases and Review</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><description>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.</description><subject>Adult</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antimicrobials</subject><subject>Bacterial arthritis and osteitis</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Biopsies</subject><subject>Bones</subject><subject>Clinical Infectious Disease Articles</subject><subject>Debridement</subject><subject>Diagnostic Errors</subject><subject>Female</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Osteitis</subject><subject>Osteitis - diagnosis</subject><subject>Osteomyelitis</subject><subject>Osteomyelitis - diagnosis</subject><subject>Osteomyelitis - drug therapy</subject><subject>Osteomyelitis - microbiology</subject><subject>Postoperative Complications</subject><subject>Pseudomonas Infections - diagnosis</subject><subject>Pseudomonas Infections - drug therapy</subject><subject>Pseudomonas Infections - microbiology</subject><subject>Pubic symphysis</subject><subject>Pubic Symphysis - diagnostic imaging</subject><subject>Pubic Symphysis - pathology</subject><subject>Radiography</subject><subject>Staphylococcal Infections - diagnosis</subject><subject>Staphylococcal Infections - drug therapy</subject><subject>Staphylococcal Infections - microbiology</subject><subject>Symptoms</subject><subject>Tomography, X-Ray Computed</subject><subject>Urinary Incontinence, Stress - surgery</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkEFv1DAQRi0EKu3CnQNIPqDesrXj2I65VQu7i1TUCgFCXCzHmSCXbLx4kkL_PW43Wg6jGel98x0eIa84W3JmxIXvwxBavOB6WS2VkU_IKZdCF0oa_jTfTNZFVYv6OTlDvGWM85rJE3JSl6oWsjwl7ibiGPeQ3BjugN5MTfD0GkeIu3vowxiQfgrYBvdziAgtdfhIH8FDGN_Rz7CPaaSxo-s4JbpyCEjd0GZwF-DPC_Kscz3Cy3kvyNf1hy-rbXF1vfm4urwqfGn0WHROt8x3TeugNCCNZExyxg2oignuWuclq5U3VadcY7SUxivhDXhe1U0pvViQ80PvPsXfE-BodwE99L0bIE5oteJcmDwLwg5BnyJigs7uU9i5dG85sw9W7WzVcm0rm63mlzdz99TsoD0-zBozfztzh971XXKDD3iMVYZpLaoce32I3Wbn6T-upBa5aEGKAw7Z8N8jdumXVVpoabfff9hv7zfr7UYpuxL_ADYKmwQ</recordid><startdate>19931001</startdate><enddate>19931001</enddate><creator>Sexton, Daniel J.</creator><creator>Heskestad, Linda</creator><creator>Lambeth, William R.</creator><creator>McCallum, Rex</creator><creator>Levin, L. Scott</creator><creator>Corey, G. Ralph</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19931001</creationdate><title>Postoperative Pubic Osteomyelitis Misdiagnosed as Osteitis Pubis: Report of Four Cases and Review</title><author>Sexton, Daniel J. ; Heskestad, Linda ; Lambeth, William R. ; McCallum, Rex ; Levin, L. Scott ; Corey, G. Ralph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c297t-fa7d0cfbdae29e5950051019e64031adac5086c94f6ab97559c63c9ec148b25c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Adult</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antimicrobials</topic><topic>Bacterial arthritis and osteitis</topic><topic>Bacterial diseases</topic><topic>Biological and medical sciences</topic><topic>Biopsies</topic><topic>Bones</topic><topic>Clinical Infectious Disease Articles</topic><topic>Debridement</topic><topic>Diagnostic Errors</topic><topic>Female</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Osteitis</topic><topic>Osteitis - diagnosis</topic><topic>Osteomyelitis</topic><topic>Osteomyelitis - diagnosis</topic><topic>Osteomyelitis - drug therapy</topic><topic>Osteomyelitis - microbiology</topic><topic>Postoperative Complications</topic><topic>Pseudomonas Infections - diagnosis</topic><topic>Pseudomonas Infections - drug therapy</topic><topic>Pseudomonas Infections - microbiology</topic><topic>Pubic symphysis</topic><topic>Pubic Symphysis - diagnostic imaging</topic><topic>Pubic Symphysis - pathology</topic><topic>Radiography</topic><topic>Staphylococcal Infections - diagnosis</topic><topic>Staphylococcal Infections - drug therapy</topic><topic>Staphylococcal Infections - microbiology</topic><topic>Symptoms</topic><topic>Tomography, X-Ray Computed</topic><topic>Urinary Incontinence, Stress - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sexton, Daniel J.</creatorcontrib><creatorcontrib>Heskestad, Linda</creatorcontrib><creatorcontrib>Lambeth, William R.</creatorcontrib><creatorcontrib>McCallum, Rex</creatorcontrib><creatorcontrib>Levin, L. 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Ralph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postoperative Pubic Osteomyelitis Misdiagnosed as Osteitis Pubis: Report of Four Cases and Review</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clinical Infectious Diseases</addtitle><date>1993-10-01</date><risdate>1993</risdate><volume>17</volume><issue>4</issue><spage>695</spage><epage>700</epage><pages>695-700</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><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.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>8268352</pmid><doi>10.1093/clinids/17.4.695</doi><tpages>6</tpages></addata></record> |
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| ispartof | Clinical infectious diseases, 1993-10, Vol.17 (4), p.695-700 |
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| source | Jstor Complete Legacy; MEDLINE; Oxford University Press Journals Digital Archive Legacy |
| subjects | Adult Anti-Bacterial Agents - therapeutic use Antimicrobials Bacterial arthritis and osteitis Bacterial diseases Biological and medical sciences Biopsies Bones Clinical Infectious Disease Articles Debridement Diagnostic Errors Female Human bacterial diseases Humans Infections Infectious diseases Magnetic Resonance Imaging Medical sciences Middle Aged Osteitis Osteitis - diagnosis Osteomyelitis Osteomyelitis - diagnosis Osteomyelitis - drug therapy Osteomyelitis - microbiology Postoperative Complications Pseudomonas Infections - diagnosis Pseudomonas Infections - drug therapy Pseudomonas Infections - microbiology Pubic symphysis Pubic Symphysis - diagnostic imaging Pubic Symphysis - pathology Radiography Staphylococcal Infections - diagnosis Staphylococcal Infections - drug therapy Staphylococcal Infections - microbiology Symptoms Tomography, X-Ray Computed Urinary Incontinence, Stress - surgery |
| title | Postoperative Pubic Osteomyelitis Misdiagnosed as Osteitis Pubis: Report of Four Cases and Review |
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