Community-Onset Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Osteomyelitis of the Pubic Symphysis

Kyung Mok Sohn; Yeon-Sook Kim; Shinhye Cheon; Hyeon Jung; Sun Hoe Koo; Deuk-Soo Hwang

doi:10.3947/ic.2011.43.3.279

Journal List > Infect Chemother > v.43(3) > 1035093

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Sohn, Kim, Cheon, Jung, Koo, and Hwang: Community-Onset Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Osteomyelitis of the Pubic Symphysis

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2011; 43(3): 279-283.

Published online: 29 June 2011

DOI: https://doi.org/10.3947/ic.2011.43.3.279

Community-Onset Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Osteomyelitis of the Pubic Symphysis

Kyung Mok Sohn¹, Yeon-Sook Kim¹, Shinhye Cheon¹, Hyeon Jung¹, Sun Hoe Koo², Deuk-Soo Hwang³

¹Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea.

²Department of Laboratory Medicine, Chungnam National University Hospital, Daejon, Korea.

³Department of Orthopedic Surgery, Chungnam National University Hospital, Daejon, Korea.

Correspondence to Yeon-Sook Kim, M.D., Ph.D. Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-280-8109, Fax: +82-42-257-5753, alice@cnuh.co.kr

Received 18 April 2011 Revised 3 May 2011 Accepted 4 May 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Osteomyelitis of the pubic symphysis or pubic osteomyelitis is a rare disease entity. Predisposing factors include trauma, pelvic or urologic surgery, intravenous drug abuse, pelvic malignancy, parturition and cardiac catheterization. Pathogens vary depending on the risk factors. The most frequent causative organism is Staphylococcus aureus . Gram-negative bacteria such as Pseudomonas aeruginosa and Escherichia coli are also common pathogens. However, pubic osteomyelitis due to community-onset extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has not previously been described. We present a patient with pubic osteomyelitis caused by ESBL-producing Escherichia coli without known predisposing factors except for diabetes.

Keywords: Osteomyelitis, Pubic symphysis, Escherichia coli, Beta-lactamases, Drug resistance

Figures and Tables

Figure 1

(A) Initial pelvic radiograph at the outpatient clinic showed normal pubic symphysis. (B) Follow up (2 weeks later) pelvic radiograph demonstrated bone destruction and irregularity of the margin of the pubic symphysis, mainly on the left side. (C) Follow up (1 month later) pelvic radiograph showed more destructive bone structure of the pubic symphysis.

Figure 2

Three phase bone scan (delayed image). Showed uptake on the symphysis pubis.

Figure 3

Magnetic resonance image. (A) T1-weighted image showed decreased signal intensity in medial aspects of both pubic bones. (B) Gadolinium enhanced T1-weighted image demonstrates an increased signal intensity. (C) T2-weighted MRI of the pelvis shows high signal intensity in medial aspects of both pubic bones. These images suggested inflammatory extension to the adjacent obturator externus and pectineus with myositis.

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