Septic arthritis of the pubic symphysis

Description

A seamstress aged 57 years presented with fever and pubic pain radiating to the hips. She had recently been treated for Staphylococcus aureus bacteraemia of unclear source. MRI revealed gadolinium enhancement of the pubic symphysis (PS). Small fluid collections consistent with infection were present in the PS and right obturator externus muscle (figures 1 and 2), but when aspiration was attempted, its size had reduced and was deemed undrainable. Blood cultures were sterile, and transoesophageal echocardiography was negative for valvular vegetations. The patient completed 8 weeks of intravenous vancomycin for septic arthritis of PS and obturator pyomyositis, with clinical and radiological resolution. She is well after 3 years of follow-up.

Figure 1

Coronal T2-weighted magnetic resonance image showing signal intensification in the pubic symphysis and right obturator externus muscle with interconnected fluid collections and hypointense peripheral rim.

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