636
Acute Pubic Osteomyelitis in Athletes Henrietta N. Ukwu, Barney S. Graham, and Robert H. Latham
From the Department of Medicine, Alvin C. York Veterans Administration Medical Center, Murfreesboro: and the Department of Medicine, Vanderbilt University Hospital and St. Thomas Hospital, Vanderbilt University School ofMedicine, Nashville, Tennessee
Three cases of pubic osteomyelitis in athletes are reported. The clinical presentation in each case was acute groin, hip, or perineal pain; fever; chills; inability to bear weight; and pubic symphysis tenderness. Since radiographic changes in the pubic bone can be delayed, a high index of suspicion is required by the clinician. Although Staphylococcus aureus is the dominant pathogen in pubic osteomyelitis, it is recommended that the diagnosis be established by culture of blood or pubic bone aspirate so that specific therapy can be instituted quickly.
Case Reports Case 1. A 21-year-old college football player developed pain in his left groin and transient fever with chills 1 month after the beginning of fall practice. Despite persistent mild pain and tenderness in his left groin, he continued to compete athletically until the pain became disabling and he developed fever, nausea, and vomiting. On admission to the hospital, his temperature was 38.7°C. He had marked tenderness over the symphysis pubis and right perineal area. Active and passive movement of the right leg was painful. Laboratory evaluation revealed a white blood cell (WBC) count of 8,400/mm 3, a hematocrit of 34%, and a erythrocyte sedimentation rate (ESR) of 61 mm/h (determined by the Westergren method). Bone scan revealed multiple defects in the pelvis. A computed tomography (CT) scan revealed bony irregularities just to the right of the pubic symphysis; tomograms confirmed cortical irregularities in the same area. Culture of fluid obtained by CT-guided aspiration yielded S. aureus. The patient was treated with nafcillin (2 g iv every 6 hours
Received 6 February 1992; revised 5 May 1992. Reprints or correspondence: Dr. Barney S. Graham, A-331 0 MeN, Vanderbilt University Hospital, Nashville, Tennessee 37232. Clinical Infectious Diseases 1992;15:636-8 © 1992 by The University of Chicago. All rights reserved. 1058-4838/92/1504-00 II $02.00
for 2 weeks), and after his condition rapidly improved, he was discharged and received dicloxacillin (1 g po four times a day for 4 months). Three weeks after discontinuing therapy with dicloxacillin, he again experienced fever, chills, and pubic pain. His temperature was 38.8°C. Pelvic bone tomograms revealed an increased joint space at the symphysis pubis and evidence of sequestration. At surgery an abscess, which involved the pelvic bone and extended into the pelvis to impinge on the bladder, was drained and debrided. He received a 2-week course ofnafcillin, and his condition again improved. The MIC and MBC of clindamycin for S. aureus were
Acute Pubic Osteomyelitis in Athletes Henrietta N. Ukwu, Barney S. Graham, and Robert H. Latham
From the Department of Medicine, Alvin C. York Veterans Administration Medical Center, Murfreesboro: and the Department of Medicine, Vanderbilt University Hospital and St. Thomas Hospital, Vanderbilt University School ofMedicine, Nashville, Tennessee
Three cases of pubic osteomyelitis in athletes are reported. The clinical presentation in each case was acute groin, hip, or perineal pain; fever; chills; inability to bear weight; and pubic symphysis tenderness. Since radiographic changes in the pubic bone can be delayed, a high index of suspicion is required by the clinician. Although Staphylococcus aureus is the dominant pathogen in pubic osteomyelitis, it is recommended that the diagnosis be established by culture of blood or pubic bone aspirate so that specific therapy can be instituted quickly.
Case Reports Case 1. A 21-year-old college football player developed pain in his left groin and transient fever with chills 1 month after the beginning of fall practice. Despite persistent mild pain and tenderness in his left groin, he continued to compete athletically until the pain became disabling and he developed fever, nausea, and vomiting. On admission to the hospital, his temperature was 38.7°C. He had marked tenderness over the symphysis pubis and right perineal area. Active and passive movement of the right leg was painful. Laboratory evaluation revealed a white blood cell (WBC) count of 8,400/mm 3, a hematocrit of 34%, and a erythrocyte sedimentation rate (ESR) of 61 mm/h (determined by the Westergren method). Bone scan revealed multiple defects in the pelvis. A computed tomography (CT) scan revealed bony irregularities just to the right of the pubic symphysis; tomograms confirmed cortical irregularities in the same area. Culture of fluid obtained by CT-guided aspiration yielded S. aureus. The patient was treated with nafcillin (2 g iv every 6 hours
Received 6 February 1992; revised 5 May 1992. Reprints or correspondence: Dr. Barney S. Graham, A-331 0 MeN, Vanderbilt University Hospital, Nashville, Tennessee 37232. Clinical Infectious Diseases 1992;15:636-8 © 1992 by The University of Chicago. All rights reserved. 1058-4838/92/1504-00 II $02.00
for 2 weeks), and after his condition rapidly improved, he was discharged and received dicloxacillin (1 g po four times a day for 4 months). Three weeks after discontinuing therapy with dicloxacillin, he again experienced fever, chills, and pubic pain. His temperature was 38.8°C. Pelvic bone tomograms revealed an increased joint space at the symphysis pubis and evidence of sequestration. At surgery an abscess, which involved the pelvic bone and extended into the pelvis to impinge on the bladder, was drained and debrided. He received a 2-week course ofnafcillin, and his condition again improved. The MIC and MBC of clindamycin for S. aureus were
