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AB0920 Tuberculosis osteomyelitis of the pubic symphysis: report of two cases
  1. R Sonia,
  2. S Boussaid,
  3. I Abdelkafi,
  4. S Hela,
  5. C Ilhem,
  6. E Mohamed
  1. Rheumatology, la Rabta, Tunis, Tunisia

Abstract

Background Infection of the symphysis pubis is a rare complication for less than 1% of cases of osteomyelitis. The predisposing causes reported are pelvic surgery, trauma and intravenous drug abuse. We report cases of osteomyelitis of the pubic symphysisdue to mycobacterium tuberculosis which is extremely

Results The two patients were 47 and 75 year-old women. They were admitted because of three month's history of progressive perineal pain and a hypogastric mass without fever in the first case, and bilateral inguinal pain with limited flexion and rotation of the right hip in the second one. Blood tests showed an elevated erythrocyte sedimentation rate (ESR) of 27 mm and 75 mm. The leucocytes rates were at 5580/mm3 and 6000/mm3. Plain X-ray revealed irregularity and widening of the symphysis pubis. Tuberculin skin test was positivein one case and negative in the other. Chest radiograph was normal. The bacteriological cultures for tubercule bacillus in sputum and urines negative. The typhic and brucellian serological diagnosis as well as blood cultures were negative. CT scan showed irregular destruction and erosion of the pubic bone with a soft tissue mass. A biopsy of the symphysis was performed. Histologic examination of the bone material revealed a granulomatous inflammation with caseous necrosis confirming the diagnosis of tuberculosis. Anti-tuberculous treatment was prescribed and led to full recovery.

Conclusions Tuberculosis is a major health problem in mediterranean countries,including Tunisia. These two cases present a timely reminder that tuberculosis should always be considered as part of the differential diagnosis of treatment of tuberculosis osteomyelitis of the pubic symphysis. Radiological investigations with plain X-rays, CT, MRI and bone scan are hepful. Treatment of tuberculous osteomyelitis of the pubic symphysis is based mainly on anti-tuberculous drugs.

Disclosure of Interest None declared

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