Osteomyelitis of the pubic symphysis caused by methicillin-resistant Staphylococcus aureus after vaginal delivery: a case report and literature review.
Adult
Anti-Bacterial Agents
/ therapeutic use
Delivery, Obstetric
Female
Fever
/ drug therapy
Humans
Levofloxacin
/ therapeutic use
Magnetic Resonance Imaging
Methicillin-Resistant Staphylococcus aureus
/ isolation & purification
Microbial Sensitivity Tests
Osteomyelitis
/ diagnostic imaging
Postpartum Period
Pregnancy
Pseudomonas aeruginosa
/ isolation & purification
Pubic Symphysis
/ diagnostic imaging
Rare Diseases
/ diagnostic imaging
Staphylococcal Infections
/ drug therapy
Treatment Outcome
Vancomycin
/ therapeutic use
Osteomyelitis
Postpartum
Pregnancy
Pubic diastasis
Septic arthritis
Staphylococcus aureus
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
08 Nov 2019
08 Nov 2019
Historique:
received:
16
08
2019
accepted:
24
10
2019
entrez:
10
11
2019
pubmed:
11
11
2019
medline:
25
2
2020
Statut:
epublish
Résumé
Osteomyelitis of the pubic symphysis is a rare cause of pelvic pain after delivery, mainly caused by Staphylococcus aureus and Pseudomonas aeruginosa. The clinical context is the same as the more common diastasis of the pubic bone, but the presence of intense local pain in association with fever should prompt further clinical work-up based on blood chemistry, microbiology and diagnostic imaging. We report the first case of methicillin-resistant Staphylococcus aureus osteomyelitis of the pubic symphysis occuring after the delivery. A 39-year-old woman developed pain over the pubic bone 12 h after the delivery. After 72 h fever rose and laboratory examination showed elevation of C-reactive protein and procalcitonin levels. Pelvic x-rays and magnetic resonance showed pubic diastasis, joint effusion, tiny irregularities of articular surfaces and, severe bone edema. The patient was started on broad spectrum intravenous (IV) antibiotics (piperacillin-tazobactam) and then replaced to IV vancomycin and oral levofloxacin based on antibiogram result. She was then discharged with oral antibiotic therapy and fully recovered. Due to the rarity of this disease, we compared our experience with the other cases of osteomyelitis of pubic symphysis occurring in peri-postpartum reported in the literature. The course of osteomyelitis was favourable in all patients, and only in one case an additional orthopedic procedure for symphysis fixation was necessary. Knowledge of this rare condition is important to enable prompt diagnosis and treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Osteomyelitis of the pubic symphysis is a rare cause of pelvic pain after delivery, mainly caused by Staphylococcus aureus and Pseudomonas aeruginosa. The clinical context is the same as the more common diastasis of the pubic bone, but the presence of intense local pain in association with fever should prompt further clinical work-up based on blood chemistry, microbiology and diagnostic imaging. We report the first case of methicillin-resistant Staphylococcus aureus osteomyelitis of the pubic symphysis occuring after the delivery.
CASE PRESENTATION
METHODS
A 39-year-old woman developed pain over the pubic bone 12 h after the delivery. After 72 h fever rose and laboratory examination showed elevation of C-reactive protein and procalcitonin levels. Pelvic x-rays and magnetic resonance showed pubic diastasis, joint effusion, tiny irregularities of articular surfaces and, severe bone edema. The patient was started on broad spectrum intravenous (IV) antibiotics (piperacillin-tazobactam) and then replaced to IV vancomycin and oral levofloxacin based on antibiogram result. She was then discharged with oral antibiotic therapy and fully recovered.
CONCLUSIONS
CONCLUSIONS
Due to the rarity of this disease, we compared our experience with the other cases of osteomyelitis of pubic symphysis occurring in peri-postpartum reported in the literature. The course of osteomyelitis was favourable in all patients, and only in one case an additional orthopedic procedure for symphysis fixation was necessary. Knowledge of this rare condition is important to enable prompt diagnosis and treatment.
Identifiants
pubmed: 31703612
doi: 10.1186/s12879-019-4595-x
pii: 10.1186/s12879-019-4595-x
pmc: PMC6842141
doi:
Substances chimiques
Anti-Bacterial Agents
0
Levofloxacin
6GNT3Y5LMF
Vancomycin
6Q205EH1VU
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
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