Rheumatology and
1 Urology Divisions, Hospital-Xeral Calde, 27004, Lugo, Spain
SIR, Osteitis pubis is a painful inflammatory condition that involves the pubic bone, symphysis and surrounding structures [1]. It is an infrequent complication of pelvic surgery, parturition or athletic activities [2, 3]. It occurs in only 0.74% of instances after MarshallMarchettiKrantz urethropexy [3] and its aetiology, pathogenesis and optimal treatment remains controversial [4]. We report a case of osteitis pubis after MarshallMarchettiKrantz urethropexy with impressive radiographic changes, and a rapid response to intravenous steroids.
A 60-yr-old woman was sent to our Rheumatology Division because of pubic pain. One year previously she had been diagnosed as having urinary incontinence, and consequently underwent MarshallMarchettiKrantz urethropexy. Forty-five days after surgery, she began to notice low abdominal pain and pubic tenderness. Urological study did not disclose any pathological changes. Four months after surgery she was referred to our unit because of persistent pubic pain. On admission, she complained of pain in the pubic area, both groins and the lower rectus abdominis muscles. The pain prevented her from walking. Physical examination revealed a temperature of 36.7°C, severe pubic pain and the impossibility of hip abduction. The erythrocyte sedimentation rate (31 mm/h) and C-reactive protein (12 mg/l; normal <5 mg/l) were slightly elevated. No abnormality of other laboratory parameters was found. The chest radiograph was also normal. A pelvis radiograph performed before surgery was normal (Fig. 1) and a new pelvis radiograph performed 4 months after surgery showed rarefaction and osteolytic changes of the pubic symphysis (Fig. 2A
). Pubic osteomyelitis and malignant neoplasm were considered, and for this reason needle bone biopsy and culture were performed. A closed, CT-guided needle biopsy disclosed avascular necrotic tissue. Bone culture was negative. Bed rest and intravenous glucocorticoids (methylprednisolone 40 mg every 8 h) for 3 days yielded rapid improvement of symptoms. A pelvis radiograph performed 1 yr later also showed radiographic improvement (Fig. 2B
).
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Treatment of non-infectious osteitis pubis is usually with non-steroidal anti-inflammatory drugs [1]. Introduction of local steroids into the pubic joint results in a quicker return to activity in college athletes [8], but intravenous steroid therapy is not standard and its efficacy should be studied prospectively.
Notes
Correspondence to: M. A. González-Gay, Division of Rheumatology, Hospital Xeral-Calde, c/ Dr Ochoa s/n, 27004 Lugo, Spain.
References