Pseudomonas aeruginosa sacroiliitis and osteomyelitis of pelvic bones after radical prostatectomy.

A 66-year-old diabetic man presented with acute incapacitating pelvic pain 6 weeks after radical prostatectomy. Symphysis pubis biopsy showed chronic osteomyelitis, and culture grew Pseudomonas aeruginosa. Despite a 7-week course of intravenous piperacillin and ceftazidime, he returned 6 months later with the same symptoms. Imaging studies and biopsy indicated right sacroiliitis and persistent pseudomonas osteomyelitis of the pelvic bones. He refused surgical debridement and was successfully treated with the same antibiotics for 8 more weeks. We emphasize the importance of bone biopsy and culture to expedite effective intravenous antibiotic therapy.