title: Septic arthritis of the pubic symphysis from Pseudomonas aeruginosa: reconsidering traditional risk factors and symptoms in the elderly patient.
abstract: A high-functioning 82-year-old man presented with lower lumbar pain and pubic tenderness. On admission he was afebrile with a normal white count. A grossly elevated C reactive protein was noted. CT scan of the pelvis showed a fluid collection anterior to the pubic symphysis and to the right of the midline measuring 2.0 × 2.2 cm. Pseudomonas aeruginosa was cultured from the fluid collection. The patient had no history of intravenous drug use, pelvic surgeries, malignancies or trauma. We report what we believe is the first documented case of P aeruginosa infection of the pubic symphysis in an elderly patient that did not have any of the traditional risk factors associated with neither P aeruginosa septic arthritis nor infections of the pubic symphysis. Instead, we propose that phimosis with chronic infection of the foreskin and balanitis may have led to septic arthritis.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, Canada. fergusto@interchange.ubc.ca
authors.forename: Fergus
authors.initials: F
authors.lastname: To
authors.forename: Penny
authors.initials: P
authors.lastname: Tam
authors.forename: Diane
authors.initials: D
authors.lastname: Villanyi
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D001446:Balanitis / Q000150:complications / Q000601:surgery; D002939:Ciprofloxacin / Q000627:therapeutic use; D002944:Circumcision, Male; D006801:Humans; D008297:Male; D010688:Phimosis / Q000150:complications / Q000601:surgery; D011552:Pseudomonas Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011550:Pseudomonas aeruginosa; D011631:Pubic Symphysis / Q000000981:diagnostic imaging / Q000382:microbiology*; D011859:Radiography; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin