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阴道分娩后耻骨联合处耐甲氧西林金黄色葡萄球菌败血症性关节炎:病例报告及文献综述

MRSA septic arthritis of the pubic symphysis post vaginal delivery: A case report and literature review.

作者信息

Al Amri Ayman, Muzaffar Rahil, Al Samsami Ibtisam

机构信息

Department of Surgery, Orthopaedic Division, Sultan Qaboos University Hospital, Muscat, Oman.

Department of Surgery, Orthopaedic Division, Sultan Qaboos University Hospital, Muscat, Oman.

出版信息

Int J Surg Case Rep. 2025 Feb;127:110905. doi: 10.1016/j.ijscr.2025.110905. Epub 2025 Jan 20.

Abstract

INTRODUCTION AND IMPORTANCE

Septic arthritis of the pubic symphysis is a rare postpartum infection characterized by severe pelvic pain, fever, and elevated inflammatory markers. It is often underdiagnosed due to its rarity and nonspecific symptoms. It is commonly caused by Staphylococcus aureus, with methicillin-resistant Staphylococcus aureus (MRSA) septic being a rare but concerning pathogen.

CASE PRESENTATION

We report the case of a 36-year-old woman who developed septic arthritis of the pubic symphysis caused by MRSA after spontaneous vaginal delivery.

CLINICAL DISCUSSION

Differentiating between diastasis and septic arthritis of the pubic symphysis is crucial for treatment. Noninfective pubic osteitis can mimic septic arthritis, presenting a diagnostic challenge. Imaging, laboratory data, and cultures are essential for accurate diagnosis. MRSA colonisation during pregnancy and postpartum trauma may facilitate infection. MRI is the most sensitive imaging modality for early detection and monitoring.

CONCLUSION

Septic arthritis of the pubic symphysis secondary to MRSA is a rare cause of postpartum pelvic pain. Prompt diagnosis and treatment are essential for favourable outcomes.

摘要

引言与重要性

耻骨联合化脓性关节炎是一种罕见的产后感染,其特征为严重的盆腔疼痛、发热及炎症指标升高。因其罕见性及非特异性症状,该病常被漏诊。其常见病因是金黄色葡萄球菌,耐甲氧西林金黄色葡萄球菌(MRSA)引起的化脓性感染虽罕见但令人担忧。

病例介绍

我们报告一例36岁女性病例,该患者在自然阴道分娩后发生了由MRSA引起的耻骨联合化脓性关节炎。

临床讨论

区分耻骨联合分离与化脓性关节炎对治疗至关重要。非感染性耻骨骨炎可类似化脓性关节炎,带来诊断挑战。影像学检查、实验室数据及培养对于准确诊断必不可少。孕期MRSA定植及产后创伤可能促使感染发生。MRI是早期检测及监测最敏感的影像学检查方法。

结论

MRSA继发的耻骨联合化脓性关节炎是产后盆腔疼痛的罕见病因。及时诊断和治疗对于取得良好预后至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f369/11795068/5664611825e4/gr1.jpg

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