Tuberculous symphysitis masquerading as a pelvic pseudotumoral mass: A case report

Tuberculosis of the pubic symphysis is extremely rare and often misdiagnosed due to its atypical presentation. It can mimic a pelvic tumor, leading to diagnostic delays. A timely diagnosis is crucial to prevent severe complications.

A 45-year-old woman presented with suprapubic pain and a progressively enlarging pelvic mass. Imaging revealed an osteolytic lesion of the pubic symphysis with fistulous tracts, suggesting a pseudotumoral process. Histopathological and microbiological analyses confirmed tuberculous osteomyelitis. Standard antituberculous therapy led to significant clinical improvement and preserved mobility at three years.

Pubic symphysis tuberculosis is often overlooked due to its indolent course. It may result from hematogenous spread or contiguous extension. Diagnosis relies on imaging, microbiological cultures, and histopathology. Differential diagnoses include pyogenic osteomyelitis, metastases, and primary bone tumors.

Although rare, tuberculosis of the pubic symphysis should be considered in atypical pelvic lesions. Prompt treatment is essential to avoid complications such as abscess formation, joint destruction, or chronic disability.