A 28-Year-Old Soccer Player With Odd Abdominal Pain, Fatigue

Thomas D. Pinkney, MB ChB; Simon F. Hobbs, MB ChB; Timothy D. Stone, MB ChB; Tim C.F. Sykes, MD, BSc, MB BCh, FRCS

Disclosures

August 09, 2021

The treatment of osteitis pubis is largely symptomatic, because most cases resolve spontaneously with physical therapy and anti-inflammatory medications. Some physicians advocate more invasive measures, such as injection of steroids or local anesthetics into the joint, or even the use of dextrose prolotherapy (injection of an otherwise nonpharmacologic irritant solution into the region of tendons or ligaments in an attempt to strengthen weakened connective tissue and thus alleviate musculoskeletal pain). No randomized controlled trials of any of these practices have been performed, and a systematic review found only level 4 evidence for all of these therapies.[10]

The mainstay of treatment of osteomyelitis pubis is a prolonged course of antibiotic therapy (initially intravenous) targeted at the causative agent. As many as 50% of cases do not fully resolve with antibiotic therapy alone and may require formal surgical debridement of the area.[9] This debridement involves curettage and jet lavage; some surgeons also implant antibiotic-impregnated beads into the affected area.[3] Whether or not surgery is performed, targeted antibiotic therapy is recommended until the erythrocyte sedimentation rate has normalized, which generally requires at least 6 weeks of antibiotic therapy.[4]

In this case, antibiotic therapy was changed to full-dose intravenous flucloxacillin based on the microbiologic sensitivities of the organisms recovered from the blood cultures. The patient was given nonsteroidal anti-inflammatory medication for pain control. Within 36 hours of this targeted antibiotic therapy, his pain improved and he remained afebrile. After daily physical therapy, he was discharged to home on hospital day 9, ambulating with crutches, and he was instructed to continue oral flucloxacillin for 8 weeks postdischarge. After completion of his antibiotic course, his symptoms had entirely resolved; he had no residual disability and was back to playing soccer.

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