Practice Lesson of the Week

Osteoarticular infection of the symphysis pubis and sacroiliac joints in active young sportsmen

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b5019 (Published 07 December 2009) Cite this as: BMJ 2009;339:b5019
  1. Kelly Cheer, speciality trainee in diabetes and endocrinology1,
  2. Sushmita Pearce, consultant physician and endocrinologist1
  1. 1Wrightington, Wigan & Leigh NHS Trust, Diabetes Centre, Royal Albert Edward Infirmary, Wigan WN1 2NN
  1. Correspondence to: K Cheer kellycheer{at}doctors.net.uk
  • Accepted 29 June 2009

Athletic patients may be susceptible to staphylococcal infection of their cartilaginous non-synovial joints

We describe two cases of young sportsmen who presented to our emergency department nine months apart with pyrexia, pain exacerbated by movement, and blood cultures positive for Staphylococcus aureus, indicative of infection of the cartilaginous joints. This unusual cause of febrile illness in athletes should not be overlooked, particularly as localising signs may not be evident at presentation. An entry site for infection is not always apparent.

Case report 1

A previously fit and well 24 year old fitness trainer presented with a three day history of increasing leg weakness and pain in his groin and gluteal regions, accompanied by fever and rigors. He had had a dental extraction one month before, without consequence.

On examination he had a temperature of 38.6°C and weakness of hip flexion of 3/5 on the MRC scale, but with normal tone, power, reflexes, and sensation elsewhere. His C reactive protein concentration was 142 mg/l, creatinine kinase concentrations were normal, and his lumbar spine radiograph was unremarkable. The differential diagnosis included transverse myelitis; therefore urgent magnetic resonance imaging of the spine and blood cultures were arranged.

Two days later he was bedridden and remained feverish. Repeat examination showed that he had no true leg weakness but had painful restriction of movement secondary to point tenderness over the symphysis pubis. Blood cultures were positive for Staphylococcus aureus and he was given intravenous flucloxacillin and rifampicin. An echocardiogram and abdominal ultrasound scan showed no source of infection, but an …

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