Table 1.

Documented cases reports of osteomyelitis of the pubic symphysis in peri/post-partum

Reference	Age	Parity	Type of delivery	Clinical features	Radiological finding	Pathogen	Treatment	Outcomes
Eskridge et al. [5]	33 years	1	Vaginal delivery with shoulder dystocia required episiotomy, suprapubic pressure and McRobert’s maneuver	Pubic pain with ambulation starting 1 day after delivery; fever; leukocytosis	Diastasis of the symphysis pubis, erosion of pubic rami, vulvar edema	Staphylococcus epidermidis Enterococcus faecalis	Intravenous (IV) ampicillin, sulbactam sodium changed to cefazolin and metronidazole Surgical debridemen	Complete recovery
Lovisetti et al. [6]	25 years	2	Normal vaginaldelivery	Pubic pain starting 1 day after delivery; fever; ↑ erythrocyte sedimentation rate (ESR), leukocytosis	Diastasis of the symphysis \pubis, bone rarefaction, suprapubic abscess	Staphylococcus aureus	IV Mezlocillin, netilmicin Surgical debridement Stabilisation of the symphysis with a Hoffmann external frame	Complete recovery
Gamble et al. [7]	37 years	1	Cesarean section	Pubic pain with ambulation starting at 28 weeks of gestation; erythema and edema over the labia, mons pubis, and lower abdomen; low grade fever; normal complete blood count	Diastasis of the symphysis pubis, enhancing mass with a high T1 signal suggesting superinfected hematoma or abscess	Staphylococcus aureus Pseudomonas aeuroginosa Serratia marcescens	IV vancomycin, levofloxacin, metronidazole Surgical debridement	Complete recovery
Ikpeme et al. [8]	28 years	Not reported	Normal vaginal delivery	Pubic pain starting 8 weeks after delivery; low grade fever; ↑ ESR, normal complete blood count	Diastasis of the symphysis pubis, irregular erosion, lytic lesions	Pseudomonas aeuroginosa	Antibiotics (not specified) Surgical debridement	Complete recovery
Dunk et al. [9]	43 years	Not reported	Normal vaginal delivery	Pubic and groin pain starting 5 days after delivery, low grade fever, leukocytosis, ↑ C-protein reactive (CPR)	Reactive sclerosis, rarefaction, osteolysis and joint irregularity	Streptococcus group G	IV cefuroxime, metronidazole Surgical debridement	Complete recovery
	31 years	Not reported	Normal vaginal delivery	Pubic pain starting 12 h after delivery, fever, leukocytosis, ↑ CPR	Reactive sclerosis, rarefaction, osteolysis and joint irregularity	Staphylococcus epidermidis	IV cefuroxime	Complete recovery
Lawford et al. [10]	27 years	1	Emergency cesarean section for fetal tachycardia with decreased variability and late decelerations to the cardiotocography	Groin pain, tenderness to palpation in the right iliac fossa with signs of peritonism, marked vulvar oedema and fever starting at 37 weeks of gestation; normal complete blood count, ↑ CPR	5 cm collection surrounding the symphysis pubis with extension into the soft tissues	Staphylococcus aureus	IV ceftriaxone, metronidazole and gentamicin changed to flucloxacillin and cephazolin based on antibiogram results	Complete recovery
Froberg et al. [11]	33 years	Not reported	Normal vaginal delivery	Pubic pain starting at 12 weeks of gestation; normal complete blood count	Fluid within the symphysis, bilateral oedema of the pubic rami and bony erosions.	Staphylococcus capitis Cutibacterium acnes	IV clindamycin	Complete recovery
Current case report	39 years	3	Normal vaginal delivery	Pubic pain starting 12 hours after the delivery; fever, leukocytosis, ↑ CPR, ↑ procalcitonin	Diastasis of the symphysis pubis, tiny irregularities of articular surfaces, pseudo-capsulated fluid collection within the symphysis, joint effusion	Methicillin-resistant Staphylococcus aureus	IV piperacillin-tazobactam changed to vancomycin and levofloxacin based on antibiogram, then after 2 weeks, oral combination of levofloxacin plus rifampicin.	Complete recovery