Groin pain in the postradiotherapy pelvis: have you considered osteomyelitis?

A man in his 80s presented to the emergency department with a 5-week history of lower abdominal and groin pain which had substantially affected his mobility. He practised intermittent self-catheterisation following radiotherapy for prostate cancer. Multiple suggestive features led to initial treatment for a urinary tract infection (UTI). However, CT imaging revealed pubic symphysis osteomyelitis with associated abdominal wall abscesses and fistulation to the prostate. This case illustrates the need to consider osteomyelitis as a differential for pain in previously irradiated body areas and to beware of diagnosing UTI where pain affects mobility.