Infect Chemother.  2011 Jun;43(3):279-283. 10.3947/ic.2011.43.3.279.

Community-Onset Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Osteomyelitis of the Pubic Symphysis

• Sohn KM
• Kim YS
• Cheon S
• Jung H
• Koo SH
• Hwang DS

• KMID: 2170352
• DOI: http://doi.org/10.3947/ic.2011.43.3.279

Abstract

Osteomyelitis of the pubic symphysis or pubic osteomyelitis is a rare disease entity. Predisposing factors include trauma, pelvic or urologic surgery, intravenous drug abuse, pelvic malignancy, parturition and cardiac catheterization. Pathogens vary depending on the risk factors. The most frequent causative organism is Staphylococcus aureus . Gram-negative bacteria such as Pseudomonas aeruginosa and Escherichia coli are also common pathogens. However, pubic osteomyelitis due to community-onset extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has not previously been described. We present a patient with pubic osteomyelitis caused by ESBL-producing Escherichia coli without known predisposing factors except for diabetes.

Keyword

Osteomyelitis; Pubic symphysis; Escherichia coli; Beta-lactamases; Drug resistance

MeSH Terms

Bacteria
beta-Lactamases
Cardiac Catheterization
Cardiac Catheters
Drug Resistance
Escherichia
Escherichia coli
Gram-Negative Bacteria
Humans
Osteomyelitis
Parturition
Pseudomonas aeruginosa
Pubic Symphysis
Rare Diseases
Risk Factors
Staphylococcus aureus
Substance Abuse, Intravenous
beta-Lactamases

Figure

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  Figure 1 (A) Initial pelvic radiograph at the outpatient clinic showed normal pubic symphysis. (B) Follow up (2 weeks later) pelvic radiograph demonstrated bone destruction and irregularity of the margin of the pubic symphysis, mainly on the left side. (C) Follow up (1 month later) pelvic radiograph showed more destructive bone structure of the pubic symphysis.

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  Figure 2 Three phase bone scan (delayed image). Showed uptake on the symphysis pubis.

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  Figure 3 Magnetic resonance image. (A) T1-weighted image showed decreased signal intensity in medial aspects of both pubic bones. (B) Gadolinium enhanced T1-weighted image demonstrates an increased signal intensity. (C) T2-weighted MRI of the pelvis shows high signal intensity in medial aspects of both pubic bones. These images suggested inflammatory extension to the adjacent obturator externus and pectineus with myositis.

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