Osteitis or osteomyelitis of the pubis? A diagnostic and therapeutic challenge: report of 9 cases and review of the literature.

TLDR

Osteitis pubis is a non‑infectious inflammation of the symphysis pubis that often follows urological or gynaecological procedures, trauma, rheumatic disease, pregnancy, or parturition, whereas osteomyelitis of the pubis is an infectious bone inflammation; distinguishing them is challenging because both present with load‑related pain, but osteitis shows normal or mildly inflammatory biochemistry while osteomyelitis is markedly inflammatory. Diagnosis relies on a 3‑phase bone scan—positive mineralisation or delayed phase suggests osteitis, all three phases indicate osteomyelitis—and definitive confirmation by aspirate culture, which typically identifies the pathogen even after antibiotic therapy.

Abstract

Osteitis pubis is a noninfective inflammation of the symphysis pubis, without distinct aetiology. It has often been reported after urological or gynaecological procedures, and is also associated with trauma, rheumatic disorders, pregnancy and parturition. Symptoms mostly resolve spontaneously. On the other hand, osteomyelitis of the pubis is a classical infective inflammation of bone. The differential diagnosis between both entities may be difficult. The most common complaint in both inflammatory diseases is pain under load, either local or pseudoradicular in nature. The biochemistry is normal or slightly inflammatory in osteitis pubis, but frankly inflammatory in osteomyelitis. A 3-phase bone scan may be positive in the mineralisation or delayed phase in case of osteitis, and in all three phases in case of osteomyelitis. Aspiration is the ultimate diagnostic test: in case of osteomyelitis pubis, culture of the aspirate will usually lead to the diagnosis, sometimes even after antibiotic therapy.