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ECR 2013 / C-2543
Septic arthritis of the pubic symphysis: Report of 5 cases and review of literature
Congress: ECR 2013
Poster No.: C-2543
Type: Scientific Exhibit
Keywords: Infection, Arthritides, Acute, Laboratory tests, Diagnostic procedure, Comparative studies, MR, CT-High Resolution, Conventional radiography, Pelvis, Musculoskeletal system, Musculoskeletal joint
Authors: J. Quispe Bravo1, J. A. Narváez2, G. C. Rivera Sierra3, J. Hernández Gañán4, E. De Lama Salvador5, R. Mast2; 1L´Hospitalet de Llobregat (Barcelona) , ESP/ES, 2HOSPITALET DE LLOBREGAT/ES, 3L´Hospitalet de Llobregat (Barcelona) /ES, 4L' Hospitalet de Llobregat/ES, 5Barcelona/ES


The data were collected in Table 1, Table 2 and Table 3.



Subsequently we performed a literature search and found an article with a review of 100 cases with arthritis of the symphysis pubis, published 2003 by Ros JJ and Hu LT.
We compare the results of this study with those of our series, and try to establish a limited differential diagnosis by imaging.



The epidemiology and clinical features are summarized in Table 1.


Fig. 38: Table 1
References: Radiodiagnostico, Hospital Universitario Bellvitge, Bellvitge - L´Hospitalet de Llobregat (Barcelona) /ES



The mean age of our patients was 61 years (range 45-64). Two of our five cases (40%) were female and 3 (60%) males.
The most common symptom was pain, present in 5 cases (100%), followed by fever (>38°C) in 4 cases (80%).
The mean duration of symptoms before diagnosis was 30 days (range 10 days to 60 days).

Neutrophilic leukocytosis (100%), and elevation of VCG and PCR levels was seen in all five cases.


Microbiological agent was obtained in:

Urine cultures (1= 20  %)

Serial blood cultures (1=  20 %)

Imaging-guided fine needle aspiration (FNA) of the symphysis pubis in 2 cases (40%)

Surgical specimens (1=20 %)


Pelvis radiographs demonstrated low sensitivity in the diagnosis of septic arthritis and osteomyelitis of the symphysis pubis, especially in the early course of the disease. Only 40% of radiographs were abnormal. Abnormal findings on radiographs include ill-defined bone erosions (n= 2; 40%), and diastasis of the pubic symphysis (n=2 40%).


The five cases of our series have been studied with pelvic CT.  CT findings included joint effusion (n=4, 80%), periarticular abscesses (n=5, 100%), bone erosions (n=3, 60%), joint cortical irregularity without frank erosions (n=2, 40%), 

periarticular soft-tissue edema (n= 3, 60%), and diastasis of the symphysis pubis in 2 (40%).
R imaging was performed in two cases. MR features were quite similar to those of the CT, but extensive bone marrow edema, with was seen in the two cases.

Risk factors are summarized in Table 2.


Fig. 39: Table 2
References: Radiodiagnostico, Hospital Universitario Bellvitge, Bellvitge - L´Hospitalet de Llobregat (Barcelona) /ES


Three main groups of risk factors were observed:

1)     Males who have undergone surgery for urinary incontinence,

2)       Women with a history of gynecological surgery

3)       Patients with history of chronic Foley catheter.


Pathogens isolated in cases of arthritis of the pubic symphysis are detailed in Table 3.


Fig. 40: Table 3
References: Radiodiagnostico, Hospital Universitario Bellvitge, Bellvitge - L´Hospitalet de Llobregat (Barcelona) /ES



Bacteriological confirmation is available in our 5 cases. The most common were S. aureus in 2 cases (40%), Pseudomonas aeruginosa in 2 cases (40%) and 1 case of polymicrobial infections (20%).
The five patients underwent broad spectrum antibiotic treatment, with the same regimen: intravenously for 4 weeks, followed by oral for 2 weeks.

The 40% of cases of our series (n=2) were treated surgically with debridement of soft tissue and bone curettage. In 40% of cases of our series (n=2), chronic complications persisted as superinfection and cutaneous fistulas.



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