A 23-year-old male patient presented with a one-day history of hypogastric and pubic pain associated with general malaise and fever.
His medical history included intermittent asthma treated with salbutamol as needed.
Upon admission, the patient was admitted with a history of urethritis.
The initial evaluation showed fever up to 37.9°C, HR 80 per minute and BP 180/76 mmHg.
On physical examination, the patient had a normal pulmonary examination, on cardiac auscultation a systolic murmur II/VI in aortic focus.
The abdomen was blandom, compressible and sensitive to hypogastric tenderness.
In the symphysis pituitary and right groin pain stood out as the main manifestation.
Bilateral inguinal lymphadenopathies were present.
Laboratory tests showed leukocytes of 12,000 x mi, with 4% of bacilliforms and a CRP of 45.47 mg/dl (normal range 0.1-5.0 mg/dl).
The AP radiograph showed, at the level of the pituitary symphysis, a mild subchondral pelvis with irregular inferior cortical margin, somewhat greater on the right.
Antibiotic treatment was initiated with cloxacillin 1 g every 6 h intravenous with the diagnosis of SPSA. The patient became febrile and started treatment with a marked commitment of the general state and appearance of an jaundice syndrome secondary to his sepsis.
The patient was admitted with fever, up to 38.4°C, hemodynamically stable.
Physical examination revealed severe pain on palpation of the pubis symphysis, with normal hip, spine and neurological examination.
Laboratory tests showed a normal white blood cell count, with 16% of bacilliforms, a CRP of 23.2 mg/dl (normal range 0.1-1.0 mg/dl), and a change in liver function tests with a cholinesterase pattern:
Two blood cultures were negative.
MRI showed findings compatible with arthritis of the pubis symphysis, with inflammatory changes of the external obturator bilaterally, larger to the right, in which a collection of 18 x 8 mm was also observed.
Abdominal CT was performed for ruling out pathological findings, which did not show any pathological findings, and pelvic CT showed only bone erosion at the symphysis p¡À level.
Antibiotic treatment was initiated with intravenous cefazolin 1 g every 8 h and intravenous clindamycin 600 mg every 8 h with good clinical and laboratory response, resolving its acute condition without requiring surgical treatment.
Together with the radiology team of our center, it was considered that the collection was not sufficient to ensure the effectiveness of the puncture and, given the good response of the patient to empirical antibiotic, it was decided to identify the causal agent non-treatment.
The patient was monitored on an outpatient basis after two weeks of antibiotic treatment and was in good general condition with complete resolution of symptoms.
