Background Septic arthritis of the pubic symphysis is rare and causes many difficulties to get the diagnosis. The risk factors are in most cases pelvic surgery, sports or drug addiction. Its management is not well codified. We report four cases.
Results : There were 2 men and 2 women. The mean age of the patients was 56 years (range 35 to 76 years). A predisposing condition was noted in 2 cases: pelvic surgery. Patients presented with hypogastric pain (3 cases) and pain in the gluteal region irradiating to the genitor-urinary organs miming sciatalgia. The fever was present in all cases. The symptoms evolved at mean since 2 months. The physical exam revealed a pain limitation of the hip and a pubic pain (4 cases). Inflammatory tests were rised in all cases. Pelvic radiography showed an irregular cortical with erosion of pubic symphysis and ischio-pubic branchs and enlarging of borders in all cases. Pelvic tomodensitometry was performed in all cases and confirmed these results in three cases and showed the presence of three collections around the pubic symphysis in one case. The bacteriological exams of these collections showed the presence of staphylococcus aureus. The anatomopathological exam, done in the other 3 cases, showed histopathologic signs of pyogenic infection in 2 cases and it was inconclusive in one case. Cytobacteriologic exam of urine revealed a Klebsiella pneumonia in one case. All the patients were treated by association of two antibiotics for 2 weeks, followed by one antibiotic for a total of 6 weeks. Evolution was excellent with resolution of pain, normalization of biologic inflammation and slow radiologic reconstructions, even for the patient with collections. Indeed, magnetic resonance imaging was perfomed a month after antibiotics beginning and has showed their clear regression.
Conclusions Infectious symphysitis should be evocated even in the absence of predisposing factors in front of prolonged fever and pain in the pelvic region. Imaging allows positive diagnosis and guide biopsy. Prognosis seems good under appropriate treatment.
Disclosure of Interest None Declared
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