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Technetium 99 m labeled bone scan with increased tracer uptake suggestive of inflammation and infection.
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Tuberculosis of symphysis pubis is a rare condition with hardly any report of such cases in the last decade. It is necessary to distinguish the entity from more common ones like Osteitis pubis and Osteomyelitis of pubis symphysis by urgent means in order to start the treatment early and thereby minimize morbidity and prevent complications. A rare c...
Context in source publication
Similar publications
Osteitis pubis represents a non-infectious inflammation of the pubic symphysis causing varying degrees of lower abdominal and pelvic pain. Although, the disease is believed to affect mainly young athletic patients, it is also encountered in other specific patient groups. Both conservative and surgical treatment options are available. While for elit...
Citations
... This analysis highlights the limitations of applying modern terms like "athlete" to ancient individuals and cautions against misinterpreting Individual 32's activities as possessing the same intensity and focus as those of a modern athlete. Judd (2009) argues that osteitis pubis is the main cause of pubic symphyseal face eburnation and draws the conclusion that the Individual 32 was an athlete; however, new evidence suggests that eburnation can also be caused by tuberculosis (Bali et al. 2010;Singh et al., 2012). For instance, in 2010, a 17-year-old non-athlete male was reported to suffer from osteoarticular tuberculosis because of an infection from bacteria, Mycobacterium tuberculosis (Bali et al., 2010), while in 2012, a 35-yearold non-athlete male was diagnosed with the same disease (Singh et al., 2012). ...
... Judd (2009) argues that osteitis pubis is the main cause of pubic symphyseal face eburnation and draws the conclusion that the Individual 32 was an athlete; however, new evidence suggests that eburnation can also be caused by tuberculosis (Bali et al. 2010;Singh et al., 2012). For instance, in 2010, a 17-year-old non-athlete male was reported to suffer from osteoarticular tuberculosis because of an infection from bacteria, Mycobacterium tuberculosis (Bali et al., 2010), while in 2012, a 35-yearold non-athlete male was diagnosed with the same disease (Singh et al., 2012). In both of the cases, eburnation caused by tuberculosis is evident on their pubic symphysis. ...
... Although the main ligaments are superior and arcuate pubic ligament which along with inter-pubic disc are the main stabilizing factors of pubic symphysis. The pubic symphysis is supplied by pubic branches of the obturator, superficial external pudendal and inferior epigastric arteries while it is innervated by branches from iliohypogastric, ilioinguinal, and pudendal nerves [4,5,6]. Infection leads to formation of metaphyseal abscess destruction of bone and loss of nutrition to hyaline cartilage. ...
... The cold abscess from pubic symphysis may track along natural passages may present at distance away from its origin. It may track to medial side of thigh along fascia of adductor muscle (present in our case), or may present in perineal area, inguinal area etc. [6,13]. The pressure due to abscess collection in retro pubic space (Cave of Retzius) may lead to urinary symptoms like polyuria. ...
Introduction
Tuberculosis (TB) of pubic symphysis is an extremely uncommon condition accounting <1% of all musculoskeletal TB. Further recurrence of TB of symphysis pubis is a rare clinical scenario requiring a high level of suspicion for diagnosing the condition. Recurrence of tuberculosis can occur either be due to relapse of the original infection or reinfection due to exogenous Mycobacterium tuberculosis strain. There have only been nine case reports on TB of the pubic symphysis in the last three decades and only 40 patients were identified in English language medical literature so to the best of our knowledge this is the first case report on the recurrence of TB of pubic symphysis.
Case Report
A 26-year-old female patient presented with pain over symphyseal area for 2 months. Laboratory and radiological investigations were suggestive of TB of symphysis pubis. She was started on oral, category I anti-tubercular therapy (ATT) from DOTS center. Patient on improvement in symptoms discontinued taking ATT after 6 months. About 7 months after stopping ATT, she again presented with pain over symphyseal area and difficulty in walking. Laboratory, radiological investigation, and biopsy were obtained to rule out multidrug-resistant (MDR) TB. The patient improved on 12 months’ oral daily ATT regime (HRZES2+HRZE4+HRE6). She was followed up for another 1 year with clinical examination and laboratory investigation after stopping ATT. At present, she is asymptomatic with no signs of recurrence after 1 year of completion of treatment.
Conclusion
ATT intake should be continued for 12 months for musculoskeletal TB for preventing recurrence. The biopsy needs to be taken from the affected region in recurrence TB to rule out MDR.
... Symphysis pubis inflammation can be either infectious or non-infectious in origin, with osteitis pubis being a self-limiting non-infectious inflammation caused by trauma, pelvic surgery, delivery, or overuse, while pubic symphysis osteomyelitis is largely bacterial in etiology and associated with pelvic malignancies, urological, trauma, and gynecological treatments, as well as intravenous drug abuse [3][4][5][6][7]. ...
... Following lymph nodes, osteoarticular tuberculosis is the second most common extrapulmonary tuberculosis presentation, accounting for approximately 13% of cases [3,10]. The most commonly affected skeletal sites are the spine, followed by the hip, knee, and ankle joints. ...
Tuberculosis is a well-known and ancient disease with a wide range of clinical presentations. Although tuberculosis is a well-known infectious disease, involvement of the symphysis pubis is rare, with only a few documented cases in the medical literature. Distinguishing it from other more common conditions, such as osteomyelitis of the pubic symphysis and osteitis pubis, is essential to avoid delay in diagnosis and to minimize morbidity, mortality, and complications. We present a rare case of tuberculosis of the symphysis pubis in an eight-year-old female from India who was initially misdiagnosed with osteomyelitis. Following the correct diagnosis and commencement of anti-tuberculosis chemotherapy, the patient demonstrated improvement in symptoms and hematological parameters at the three-month follow-up. This case emphasizes the importance of considering tuberculosis as a differential diagnosis in cases of symphysis pubis involvement, especially in areas with a high incidence of tuberculosis. Early diagnosis and appropriate treatment can prevent further complications and improve clinical outcomes.
... Skeletal TB accounts for 10-15% of all cases of extra-pulmonary tuberculosis [1,2]. It can involve uncommon sites of the body [3] such as the pubic bone, sacroiliac and sternoclavicular joints [4]. Only 40 cases of pubic bone TB has been described in the medical literature till now [5] out of which only one case has presented with labial swelling [6]. ...
Introduction:
Skeletal tuberculosis (TB) accounts for 10-15% of all cases of extra-pulmonary TB. The involvement of pubis is extremely rare with only 40 cases of pubic bone TB reported in the medical literature. The presentation of the disease with labial abscess is much rarer with only one case reported till now.
Case report:
A 23-year-old female presented with symptoms of pain and swelling in the right groin. The patient was evaluated with hematological and radiological investigations and the diagnosis of Tubercular osteomyelitis of pubis with labial abscess was confirmed using AFB staining and culture of the aspirate. The patient was subsequently managed with Anti-tubercular chemotherapy for 18 months and the lesion healed with excellent functional outcome.
Conclusion:
Tubercular Osteomyelitis of the pubis is a rare disease with varied clinical presentation. Timely diagnosis and anti-tubercular chemotherapy usually result in complete recovery.
... The pubic symphysis tuberculosis is a rare and uncharacteristic. In the last 30 years only 9 cases were reported [7]. ...
... The possibility of different interpretation of the clinical signs renders the diagnosis as a difficult feat. The lack of genitourinary symptomatology increases the difficulty even further, making it so that it can be easily mistaken with: unspecific osteitis, blood diseases and bone metastasise [7,34,35]. ...
Osteoarticular tuberculosis (OATB) is a secondary chronic infection with paubacillary bacillus Koch (BK) that has bone and joint interest. Today in Romania, tuberculosis is a primary public health problem, according to World Health Organization (WHO) in 2015 alone, there have been 10.4 million new cases of tuberculosis (TB) in the world, of which 15.195 in Romania. Pulmonary and extrapulmonary tuberculosis, especially the osteoarticular form, with multiple outbreaks should of had a minimal impact, but because of the multiple characteristics such as: epidemiological, geographic, associated diseases, diagnosis capacity, therapeutic options, gene pool and racial evolutiv traits, the disease spreading and management in both developed and underdeveloped countries, the TB infection has seen an increase in the number of cases (e.g. Africa and Asia). Today there is a fecundity upsurge of BK infection, especially pronounced in low income populations, country side people being the most affected. There are multiple breakthroughs in the understanding of Mycobacterium tuberculosis physiopathology. This fact offers us a modern and genetically guided approach in the diagnosis, evolutive patterns and treatment involving the OATB.
... Sacroiliac joint involvement occurs in up to 2% of people with skeletal TB, and is commonly bilateral. Involvement of the ilium and sacroiliac joint is usually considered as secondary to Pott's disease with a psoas abscess, or gastrointestinal TB, and is usually not encountered until late in childhood or even into young adulthood (Kremer and Wiese, 1930;Sorrel and Sorrel-Dejerine, 1932: 501;Konschegg, 1934;Aufderheide and Rodríguez Martin, 1998: 139;Roberts and Buikstra, 2003: 98;Bali et al., 2010). ...
Clear skeletal evidence of prehistoric tuberculosis (TB) is rare, especially in children. We describe and differentially diagnose the pathological changes displayed by a five-year-old child, Pollera 21 (PO21) dated to the Middle Neolithic of Liguria (Italy), or 5740 ± 30 BP (Beta-409341; 6635–6453 cal BP, 2σ, OxCal 4.2). PO21 shows a number of osteoarticular lesions, mainly of a lytic nature with very little bone proliferation: the vertebral column, the shoulder and pelvic girdles, and the ribcage are involved. Given the nature and pattern of the lesions, we propose a diagnosis of multifocal (or multiple) bone TB. Attempts to detect TB aDNA through molecular analysis gave negative results, but this alone is not sufficient to prove that PO21 was not infected with TB. The lesions observed in PO21 share similarities with other published evidence, such as spinal and joint involvement, and disseminated cyst-like lesions. Conversely, PO21 does not show diffuse bone deposition, such as hypertrophic osteoarthropathy (HOA) or endocranial modifications such as serpens endocrania symmetrica (SES). PO21 adds to our knowledge of patterns of TB manifestation in archaeological skeletal remains, which is especially important considering the variability in types and patterns of osteoarticular lesions seen today in people with TB.
... [1] Tuberculosis of the pubis symphysis is still uncommon with only nine cases reported in the past three decades. [2] However, in the pre-chemotherapy era in the earlier part of the century, up to 100 cases have been reported, which have all been diagnosed in advanced stages. [2] Though rare, it nevertheless warrants greater emphasis to allow for differentiation from other infective or non-infective inflammatory conditions of pubic symphysis, especially osteitis pubis which is a self-limiting non-infective inflammation of the pubic symphysis. ...
... [2] However, in the pre-chemotherapy era in the earlier part of the century, up to 100 cases have been reported, which have all been diagnosed in advanced stages. [2] Though rare, it nevertheless warrants greater emphasis to allow for differentiation from other infective or non-infective inflammatory conditions of pubic symphysis, especially osteitis pubis which is a self-limiting non-infective inflammation of the pubic symphysis. Osteitis pubis is usually a self-limiting inflammation of the pubic symphysis secondary to trauma, pelvic surgery, childbirth, or overuse. ...
... To our knowledge, there are only nine cases reported in the last three decades. [2,[8][9][10][11][12][13][14] TB of the pubis has a varied clinical presentation, initially being asymptomatic to the most common presentation of an abscess and swelling in the hypogastric, perineal, medial thigh, or ischiorectal area. [13] The earliest symptom is a feeling of tiredness in the legs, and perhaps waking with a limp, without any demonstrable changes in the legs. ...
Symphysis pubis is an uncommon site of tuberculosis and only few cases have been reported in the literature. It is important to distinguish it from the more common entities like Osteitis pubis and Osteomyelitis of pubis symphysis to prevent delay in diagnosis and minimize morbidity and prevent complications. We report a rare case of tuberculosis of symphysis pubis in a 50-year-old Indian female from low socioeconomic status. Diagnosis is not difficult if one is aware of the condition. A high index of suspicion along with radiograph and fine needle aspiration led to the diagnosis. The patient had an excellent outcome following a complete course of anti-tuberculous chemotherapy for tuberculosis.
... The increasing incidence of immunodeficiency disorders and use of tumor necrosis factor-alpha (TNF-a) antagonist predispose patients to TB even in the developed world. TB can involve uncommon sites of the body [3]. TB in drug users has a predilection for rare sites such as the pubic symphysis and the sacroiliac and sternoclavicular joints [24]. ...
... The pubic symphysis receives its blood supply from the inferior epigastric, pudendal, medial circumflex femoral and obturator arteries [8]. TB of the pubic symphysis is mostly blood borne [3] (as in our Patient 4 with multisystem TB) and the infection spreads hematogenously to the metaphyseal bone and the fibrocartilage of the pubis. The other less common although important source of infection is locally through the adjacent genitourinary tract or related therapeutic procedures [5,24]. ...
... With our literature review and our four patients, we found that the diagnosis of symphysis TB is delayed in many patients for months to years and these are patients who have been treated for other conditions [3,7,26,38,46]. A delay in diagnosis is attributed to lack of knowledge regarding this uncommon problem, vague symptoms and signs, and resemblance to other diseases of the pubic symphysis. Pubic TB should be differentiated from conditions such as osteitis pubis, a noninfective chronic inflammation of the pubic symphysis which is more common and closely mimics pubic TB [3,6,7,46]. ...
Background
The incidence of extrapulmonary tuberculosis (TB) has increased in the chemotherapeutic era owing to the increasing presence of immunodeficiency disorders. Pubic symphysis TB, although uncommon, is again important as these infections once were in the prechemotherapeutic era.
Case Description
We present the cases of four patients with pubic symphysis TB in which one patient had a horseshoe-shaped abscess in the pubic region and another had a double lesion of the pelvis leading to vertical shear-type pathologic displacement. Three patients were diagnosed by cytology and PCR. These patients were treated successfully with antituberculosis treatment with or without minimal surgical intervention despite their late presentation and advanced disease. The fourth patient remains under treatment and followup.
Literature Review
We identified 40 patients with TB of the pubic symphysis in the English language medical literature. Of these 40 patients, only five are from India despite TB being endemic in this country. Followup information is available for 32 of the 40 patients with followups ranging from 1 to 84 months (mean of approximataly 20 months).
Purposes and Clinical Relevance
We suspect TB of the pubic symphysis is increasing in frequency owing to drug resistance, use of biologics, immunomodulating drugs, and anticancer drugs. Therefore, it is important for clinicians to have a high index of suspicion in patients at risk. Initially patients may be asymptomatic or present with adductor region pain or spasm, sacroiliac strain, limp, or a hypogastric, inguinal, or thigh mass that mimics an inguinal hernia, genitourinary, abdominal, or thigh tumor.
Conclusion
It is important to diagnose and treat pubic TB early in the course of the disease before the destructive stage. After relevant investigations most patients can be treated with antitubercular drugs with or without a minor surgical procedure.
... [1][2][3][4] Few reports in literature highlight osteomyelitis and tuberculosis of symphysis pubis. [6,7] Post-traumatic osteitis pubis is 5 times more prevalent in males involved in sports activities, and its reported incidence is 0.5-7%. [5] The pathogenesis of osteitis pubis is not clear, it has been hypothesized that following an initial strain a cycle of event is created which is exacerbated by further activity. ...
Minor musculoskeletal injuries usually heal within few weeks with conservative treatment, but in pelvic injuries, symptoms may persist for long duration and patient need medical attention to get relief from disturbing pain symptoms. We present a case of post-trauma osteitis pubis in a 58-year-old female, who reported with lower abdominal and left side hip joint pain since 2 months, after an episode of trivial trauma to her pelvis. Technetium-99m methylene diphosphonate bone scintigraphy was performed, which confirmed the site of injury in symphysis pubis and left hip joint, by increased radiotracer localization at both of these symptomatic sites.
... Tuberculosis of the pubic symphysis is rare and few cases have been presented in the literature in the past three decades. [2][3][4][5][6][7][8][9][10][11] Likewise, uncertainty on management still prevails. Though rare, it nevertheless warrants greater emphasis to allow for differentiation from other infective or non-infective inflammatory conditions of pubic symphysis, especially osteitis pubis which is a self-limiting non-infective inflammation of the pubic symphysis. ...
Tuberculosis is one of the oldest diseases affecting mankind and is known for its ability to present in various forms and guises. Pubic symphysis is an uncommon site for tuberculous affliction; hence very few cases have been reported in the English-language literature. We present a rare case of pubic symphysis tuberculosis diagnosed as osteitis pubis before presentation to our institution. The patient made an uneventful recovery following antitubercular chemotherapy.
