Pubic osteomyelitis complicated by a rectus abdominis abscess and urethral fistula: a rare case report.

BACKGROUND: Pubic osteomyelitis is an uncommon condition that is typically reported in patients with a history of pelvic surgery or immunosuppression. Its clinical presentation, which often includes lower abdominal pain and persistent fever, is nonspecific, making its diagnosis challenging. Advanced imaging modalities, particularly computed tomography (CT), are essential for accurate diagnosis. CASE PRESENTATION: An 85-year-old woman initially diagnosed with a urinary tract infection was referred for clinical deterioration. Contrast-enhanced CT revealed a large abscess in the rectus abdominis and osteolytic changes in the pubic bones. Contrast instillation via the drainage catheter demonstrated communication between the abscess cavity and urethra, which was confirmed by the appearance of indigo carmine dye in the urethral meatus. The patient improved with drainage and antibiotic therapy and was transferred for rehabilitation on hospital day 42. CONCLUSIONS: This case highlights that pubic osteomyelitis can develop even in the absence of typical predisposing factors such as pelvic surgery or immunosuppression. It also highlights that chronic tract infections may serve as a potential source, possibly leading to complex complications such as urethro-abscess fistulas. CLINICAL TRIAL NUMBER: Not applicable.