Septic arthritis affecting pubic symphysis

A 26-year-old man presented to accident and emergency with a 1-week history of fever, rigors and sudden onset of severe left testicular pain. The symptoms started without trauma and pain radiated to the abdomen and was worse on walking. He had raised temperature and inflammatory markers. He reattended 2 days later with progressive bilateral groin pain, night sweats and the blood cultures grew Staphylococcus aureus. Repeat cultures were sent and the patient was arranged to be followed up in clinic. He returned 5 days later with worsening symptoms. S aureus was grown from the second blood culture, so he was admitted for intravenous flucloxacillin. MRI of the pelvis showed a small fluid collection around the pubic symphysis and extensive periarticular bone marrow oedema consistent with septic arthritis and a retropubic abscess. He was treated with a 8-week course of flucloxacillin with complete resolution.