Septic arthritis of the pubic symphysis is a rare condition that can affect healthy young athletes or women who have undergone a urologic or gynecologic surgery. It is usually misdiagnosed with osteitis pubis, a sterile inflammation of the pubic symphysis in young athletes due to repetitive or strenuous activities. It accounts for fewer than 1% of all cases of septic arthritis. Staphylococcus aureus is the most common etiology. We describe a female who presented to ER with fever and right lower quadrant (RLQ) pain that was finally diagnosed with septic arthritis of the pubic symphysis. An otherwise healthy 19‐year‐old college student and cross‐country runner female referred to ER with high‐grade fever, rigors, and RLQ pain. She had been seen by another ER facility with milder symptoms 10 days before, and physical exam, labs and abdominal CT were unremarkable for acute appendicitis. She was sent home with NSAIDs. Three days later she appeared ill with high‐grade fever and was referred to ER again which she was diagnosed with viral infection and sent home with supportive therapy. She also complained of nausea, generalized weakness and malaise; denied sick contact, travel outside of the United States and diarrhea. She used to run ten miles a day and denied any tobacco, alcohol or illicit drug use. Her vital signs revealed a temperature of 104.0°F, and on physical, she appeared sick, with tachycardia and tachypnea and O2 saturation of 98% on room air. The right groin and hip were tender and her gait was antalgic. No lymphadenopathy, hepatosplenomegaly, rash, jaundice, or peritoneal signs were appreciated. Rest of her physical including pelvic exam was unremarkable. Initial labs revealed mild leukocytosis (with 83% neutrophils) and ESR was 152. Abdominopelvic CT showed a cystic mass in front of the bladder, suggesting remnant of a urachal cyst with mild distension of the appendix. Blood culture was sent and she was started on empirical antibiotics with vancomycin and piperacillin/tazobactam for possible appendicitis. To rule out musculoskeletal etiologies, MRI of the pelvis was requested as well, which showed osteomyelitis of the pubic body and septic arthritis of pubic symphysis. Blood culture results came back positive for Staphylococcus coagulase negative. The patient was started on cephazolin to continue for 6 weeks with significant improvement, which was also confirmed with repeat MRI study.
Septic arthritis and osteomyelitis of the pubic symphysis should always be suspected in young healthy athletes who present with septic features, groin pain and gait abnormalities. Early diagnosis and treatment with further rehabilitation can prevent bony destructions and prolonged disabilities.
We believe in our patient microtrauma to the feet due to running is considered as the source of bacteremia. This can seed in the joints, which are more involved in strenuous activities.
To cite this abstract:Pourpaki M, Raeissi S, Blatt S. Septic Arthritis of the Pubic Symphysis in a Young Athlete: Commonly Misdiagnosed. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 431. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/septic-arthritis-of-the-pubic-symphysis-in-a-young-athlete-commonly-misdiagnosed/. Accessed March 31, 2020.