Alaya Zeineb, Zaghouani Houneida, Osman Walid, Hassini Lassad, Naouar Nader, Ben Ayèche Mohamed Laziz, Bouajina Elyès
Department of Rheumatology, Farhat Hached Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia.
Department of Radiology, Farhat Hached Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia.
Pan Afr Med J. 2017 Apr 24;26:215. doi: 10.11604/pamj.2017.26.215.12204. eCollection 2017.
Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and therapeutic aspects of this disease. This is a retrospective study of 4 cases of septic arthritis of the pubic symphysis collected in the Department of Rheumatology and Orthopaedics in Sousse in Tunisia over a period of 16 years (2000-2016). Our population consists of 3 women and one men. The mean age was 47 years (18-83). Clinical signs of appeal were inflammatory groin pain, pubic pain and fever. Symptoms appeared after forceps delivery in 2 cases, after surgery on the pelvis in one case and in a context of sepsis in one case. Radiographs showed pubic disjunction with irregular shoreline in all cases. CT performed in all patients and MRI in 2 patients showed erosions of the banks of the pubic symphysis with infiltration of the soft parts in all cases. The causative organisms were isolated in 3 cases by biopsy of soft tissue abscess under CT in 2 cases and vaginal swab in one case. Identified germs were staphylococcus aureus Méti-S (n=1), proteus mirabilis (n=1) and varied flora (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in 2 cases. The outcome was favorable in all cases. Diagnosis of septic arthritis of the pubic symphysis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase.
耻骨联合化脓性关节炎罕见且难以诊断。我们研究的目的是描述这种疾病的生物学、临床、放射学和治疗方面。这是一项回顾性研究，收集了突尼斯苏塞风湿病与骨科在16年（2000 - 2016年）期间的4例耻骨联合化脓性关节炎病例。我们的研究对象包括3名女性和1名男性。平均年龄为47岁（18 - 83岁）。主要临床症状为腹股沟炎性疼痛、耻骨疼痛和发热。2例症状出现在产钳助产术后，1例出现在骨盆手术后，1例出现在败血症背景下。所有病例的X线片均显示耻骨分离且边缘不规则。所有患者均进行了CT检查，2例患者进行了MRI检查，结果显示所有病例耻骨联合边缘均有侵蚀且软组织有浸润。3例通过CT引导下软组织脓肿活检（2例）及阴道拭子检查（1例）分离出致病微生物。鉴定出的病菌为耐甲氧西林金黄色葡萄球菌（n = 1）、奇异变形杆菌（n = 1）和多种菌群（n = 1）。所有病例均采用了适当的抗生素治疗，2例对药物治疗耐药的软组织脓肿进行了手术引流。所有病例预后良好。耻骨联合化脓性关节炎的诊断基于临床症状，并得到微生物培养结果、影像学方法及急性期蛋白升高的支持。
