Ostéomyélite de la symphyse pubienne : il suffit d'y penser

We report the case of a young patient being seen for abdominal pain in the left lower quadrant (LLQ). He was febrile and his abdominal palpation normal, which led to the discovery of a pubic osteomyelitis caused by Staphylococcus aureus. The differential diagnosis of abdominal pain in the LLQ is complex. Diagnosing pelvic osteomyelitis is based on the combination of pelvic pain, radiological anomalies in the pelvic girdle and a positive bacteriological test. In this observation, initially the only practical sign that could lead towards a pubic osteomyelitis diagnosis was psoitis; there was no spontaneous pain of the symphysis, and pain caused by palpation/percussion was not looked for. Blood cultures and ultrasound gave the basis for the diagnosis of pubic osteomyelitis caused by a methicillin-sensitive S. aureus. In the diagnosis of pubic osteomyelitis, a simple clinical diagnosis confirmed by imaging should be part of the differential diagnosis to be discussed by the A&E doctor, when presented with febrile abdominal pain and a normal clinical abdominal examination.