When MRSA Misleads: Tuberculous Osteomyelitis of the Anterior Pelvic Bones
Abstract
Introduction: Osteomyelitis of the pubic symphysis is rare, representing less than one percent of all osteomyelitis cases, and is frequently misdiagnosed as genitourinary pathology owing to overlapping symptoms and anatomical proximity. Tuberculous involvement at this site is exceptional, and concurrent infection with methicillin-resistant Staphylococcus aureus (MRSA) remains infrequently documented. This case contributes to orthopedic literature by demonstrating how reliance on blood and pus cultures alone can delay recognition of occult mycobacterial disease in culture-discordant pelvic osteomyelitis, reinforcing the indispensable role of surgical biopsy and histopathology in guiding combined antimycobacterial and antistaphylococcal therapy.
Case report: A 40-year-old South-Asian woman with hypothyroidism and recurrent urinary tract infections presented with 2 weeks of progressive suprapubic pain radiating to both lower limbs and high-grade fever. Examination revealed fever, suprapubic tenderness, and restricted bilateral hip movements. Laboratories showed neutrophilic leukocytosis and elevated C-reactive protein. Blood culture grew MRSA; urine and ultrasound-guided prepubic pus cultures were sterile. Magnetic resonance imaging confirmed bilateral pubic bone osteomyelitis, superior rami involvement, abscesses, and myositis. Symptoms persisted despite intravenous teicoplanin, prompting surgical debridement. Curetted bone histopathology demonstrated necrotizing granulomatous…
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