title: Vulvar ulcer causing osteomyelitis of the pubic bone.
abstract: BACKGROUND
  Osteomyelitis of the pubic bone is a rare entity. Risk factors for infection of the symphysis pubis and osteomyelitis of the pubic bone include direct trauma, previous urogynecologic procedures, extreme physical exercise, and immunocompromised state. The treatment modalities range from conservative antibiotic treatment to extensive surgery.
  
  
  METHODS
  A 49-year-old woman with multiple sclerosis and borderline diabetes mellitus presented with bloody vulvovaginal discharge. The source was found out to be an ulcer located above the urethra with exposure of the underlying symphysis pubis. Intraoperative debridement of the ulcer followed by bone biopsies demonstrated osteomyelitis of the pubic bone. Prolonged intravenous antibiotics and 4 operative debridements were needed before the osteomyelitis was adequately addressed and the defect could be closed with a bulbocavernosus flap.
  
  
  CONCLUSIONS
  This is the first report of a severe case of osteomyelitis of the pubic bone arising from a vulvar ulcer.
authors: Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel. bina.cohensacher@gmail.com
authors: Bina
authors: B
authors: Cohen-Sacher
authors: Yaa
authors: Y
authors: Amankwah
authors: Paul S
authors: PS
authors: Cederna
authors: Cynthia A
authors: CA
authors: Brincat
authors: Hope K
authors: HK
authors: Haefner
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003646:Debridement; D005260:Female; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D011630:Pubic Bone / Q000473:pathology*; D014456:Ulcer / Q000175:diagnosis* / Q000473:pathology*; D014845:Vulvar Diseases / Q000150:complications* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents