Infectious Pubic Symphysitis: An Atypical Infection Not to Be Overlooked

The pubic symphysis is a rare site for septic arthritis. We report a case of infectious pubic symphysitis occurring in the postpartum period. A 33-year-old woman, gravida 2, para 2, with one living child and one stillbirth at 6 months of gestation was admitted 10 days postpartum with pubalgia and bilateral subacute inflammatory hip pain associated with fever. Initial examination revealed systemic inflammatory response syndrome. Rheumatological assessment showed bilateral clinostasis, tenderness on pubic palpation, and painful hip mobilization with a positive FABER test. Laboratory findings showed elevated inflammatory markers with a C-reactive protein (CRP) level of 338.15 mg/L. Blood cultures identified Escherichia coli sensitive to amoxicillin-clavulanic acid. Urinary cytobacteriological examination was sterile. Magnetic resonance imaging (MRI) revealed edema of the pubic symphysis and significant pelvic muscle infiltration with an intersymphyseal fluid collection extending to the hip joints. Joint fluid aspiration could not be performed due to the low volume. The diagnosis of infectious pubic symphysitis and septic hip arthritis was established. Targeted antibiotic therapy with amoxicillin-clavulanic acid (4 g/day) was initiated, leading to clinical improvement and a significant decrease in inflammatory markers. Although septic pubic arthritis is rare, it should be considered in cases of pubalgia with fever, particularly in postpartum settings where microbial seeding of the pubic symphysis may occur.