Tuberculosis of the Pubic Symphysis: Four Unusual Cases and Literature Review

Abstract

Background The incidence of extrapulmonary tuberculosis (TB) has increased in the chemotherapeutic era owing to the increasing presence of immunodeficiency disorders. Pubic symphysis TB, although uncommon, is again important as these infections once were in the prechemotherapeutic era. Case Description We present the cases of four patients with pubic symphysis TB in which one patient had a horseshoe-shaped abscess in the pubic region and another had a double lesion of the pelvis leading to vertical sheartype pathologic displacement. Three patients were diagnosed by cytology and PCR. These patients were treated successfully with antituberculosis treatment with or without minimal surgical intervention despite their late presentation and advanced disease. The fourth patient remains under treatment and followup. Literature ReviewWe identified 40 patients with TB of the pubic symphysis in the English language medical literature. Of these 40 patients, only five are from India despite TB being endemic in this country. Followup information is available for 32 of the 40 patients with followups ranging from 1 to 84 months (mean of approximataly 20 months).

A persistent case of tuberculosis of the pubic symphysis and pubic bone

“…TB of the symphysis and pubic bone, as in our case, is very rare, though it has been previously reported in the literature 13 17 18. Clinical symptoms of musculoskeletal TB are often unspecific 8.…”

Rare manifestations of spinal tuberculosis in the Robert J. Terry Anatomical Skeletal Collection (National Museum of Natural History, Smithsonian Institution, Washington, DC, USA)

“…Nevertheless, tuberculous involvement of the sacroiliac joint is rather uncommon (affecting approximately 3–10% of osteoarticular TB cases) and usually results from direct extension of a spinal TB focus (Gupta, Bienenstock, Morano, & Gupta, ; Papagelopoulos et al, ). The adjoining surfaces of the two pubic symphyses (Figure c,d) revealed severe destruction that is suggestive of TB symphysitis, representing an unusual site of the disease (Lal, Jain, & Kannan, ; Meena & Gangary, ; Ortner, ).…”

“…representing an unusual site of the disease (Lal, Jain, & Kannan, 2013;Meena & Gangary, 2015;Ortner, 2003).…”

Labial swelling: a rare presentation of pubic bone tuberculosis

“…3 Pubic bone TB may present as spread from nearby anatomical locations. [7][8][9] The lesion may present as a non-healing sinus 1 or as a cold abscess. Extension to the labia is exceptionally rare.…”

“…Tuberculosis (TB) presenting in the pubic bone is rare. Only 40 cases of pubic bone TB were identified by Hitesh et al 1 and its presentation as a labial swelling has not previously been reported.…”