Osteomyelitis pubis caused by Pseudomonas aeruginosa secondary to surgical site infections subsequent to vulvar cancer surgeries: A case report

Secondary osteomyelitis pubis is rare, particularly when it arises due to genitourinary postoperative infections, such as those occurring after vulvar cancer surgeries. Diagnosis and treatment of secondary osteomyelitis pubis are challenging. Here, we report on two cases of osteomyelitis pubis caused by Pseudomonas aeruginosa secondary to surgical site infections after of vulvar cancer surgeries. Both patients were in their 80 s and underwent vulvectomy and vulvar reconstructive surgery using skin flaps. The patients were discharged from the hospital after postoperative antimicrobial treatment for surgical site infections and continued self-cleaning of the wound dehiscence. Both patients presented, respectively, with gait disturbance due to pain in the pubic bone postoperatively at 24 and 7 weeks. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed to confirm the diagnosis of osteomyelitis pubis. The patients underwent pubic bone debridement, and tissue culture revealed the presence of Pseudomonas aeruginosa that required several months of antimicrobial therapy. Pubic pain and gait disturbance improved with treatment, and no osteomyelitis pubis relapse has been observed in both cases 12 and 9 months since treatment initiation. CT and MRI were useful in diagnosing osteomyelitis pubis. Early debridement helped identify the causative organism and appropriate antibiotics selection.