Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 47, Num. 1, 2001, pp. 54

Journal of Postgraduate Medicine, Vol. 47, Issue 1, 2001 pp. 54

Tuberculosis of Pubic Symphysis Presenting with Hypogastric Mass

Balsarkar DJ, Joshi MA

Department of General Surgery, LTMMC and LTMG Hospital, Sion, Mumbai - 400 022, India.

Case History

A 28-year-old male patient presented with a swelling in the hypogastrium since one and a half months associated with a history of chronic cough, anorexia and weight loss. There was no history of tuberculosis in self or contact with patient with tuberculosis. On examination there was a 5 x 5 cms soft, intrapariet al swelling in the hypogastrium. A clinical diagnosis of haemangioma of the pariet al wall of the hypogastrium was made.

X-ray of the pubic bones showed bony erosion of the public symphysis (Figure 1). Ultrasonography showed a 5 x 4 cms intrapariet al swelling in the hypograstric region. Computerised tomographic (CT) scan of the abdomen showed a 5 x 5 cms intrapariet al swelling in the hypograstrium with erosion of the public symphysis (Figure 2). CT guided needle aspiration of pus showed presence of acid fast bacilli. Fluid adenosine deaminase level was 284 U/L (normal of 0.1-22 U/L). Patient was started on antituberculous drugs and he showed good response. The hypogastric mass disappeared three months after treatment.

Discussion

Pubic bone is an exceptional site of tuberculous infection.1,2 Early diagnosis is essential before destructive changes set in.2 Clinical signs noted are inflammatory pain in the pubic region and a hypogastric cystic mass.2,3

Present case had a hypogastric lump. X-ray of local part shows irregular osteolysis of pubic bone, as was noted in reported case.2 CT scan helps in confirming the diagnosis by demonstrating the presence of cystic mass with destruction or erosion of the pubic bone, as was well documented in the present case.3 Confirmatory diagnosis is by demonstration of acid fast bacilli from pubic foci-aspirate.2 Raised fluid adenosine de-aminase levels help in supporting the diagnosis of tuberculosis. The treatment of choice is a short course of anti-tuberculous drugs for six months.2

Diagnosis of pubic tuberculous osteoarthritis should be considered in unexplained causes of pubic pain especially in endemic countries.

References

1. Tsay MH, Chen MC, Juang GY, Pang KK, Chen BF. Atypical skelet al tuberculosis mimiciking tumor metastases: report of a case. J Formos Med Assoc 1995; 94:428-431. MEDLINE
2. Benbouazza K, Allali F, Bezza A, el Hassani S, el Maghraoui A, Lazark N, et al. Pubic tuberculous osteo-arthritis. Apropos of 2 cases. Rev Chir Orthop Reparatrice Appar Mot 1997;83:670-672. MEDLINE
3. Manazaneque L, Marin I, Garcia-pagado F, Beizteugi A, Dastis C, Sanchez-Matas P. Osteoarticular tuberculosis of the symphysis pubic presenting as a hypogastric mass in a woman with primary sjogrens syndrome. p J Rheumatol 1992; 31:495-496. MEDLINE

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