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Vulvar Ulcer Causing Osteomyelitis of the Pubic Bone

Cohen-Sacher, Bina MD1; Amankwah, Yaa MBChB2; Cederna, Paul S. MD3; Brincat, Cynthia A. MD, PhD4; Haefner, Hope K. MD5

Journal of Lower Genital Tract Disease: April 2013 - Volume 17 - Issue 2 - p 230–233
doi: 10.1097/LGT.0b013e318260e872
Case Reports

Background Osteomyelitis of the pubic bone is a rare entity. Risk factors for infection of the symphysis pubis and osteomyelitis of the pubic bone include direct trauma, previous urogynecologic procedures, extreme physical exercise, and immunocompromised state. The treatment modalities range from conservative antibiotic treatment to extensive surgery.

Case A 49-year-old woman with multiple sclerosis and borderline diabetes mellitus presented with bloody vulvovaginal discharge. The source was found out to be an ulcer located above the urethra with exposure of the underlying symphysis pubis. Intraoperative debridement of the ulcer followed by bone biopsies demonstrated osteomyelitis of the pubic bone. Prolonged intravenous antibiotics and 4 operative debridements were needed before the osteomyelitis was adequately addressed and the defect could be closed with a bulbocavernosus flap.

Conclusions This is the first report of a severe case of osteomyelitis of the pubic bone arising from a vulvar ulcer.

Case report of osteomyelitis originating from a vulvar ulcer requiring several surgical debridements and closure with a bulbocavernosus flap.

1Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel; 2Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, University of Ottawa, Ontario, Canada; 3Department of Plastic Surgery, University of Michigan Hospitals, Ann Arbor, MI; 4Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, WI; and 5Department of Obstetrics and Gynecology, University of Michigan Hospitals, Ann Arbor, MI.

Reprint requests to: Bina Cohen-Sacher, MD, 1 Ha’oren St, Kochav Ya’ir, Israel. E-mail:

The authors declare there are no conflicts of interest.

©2013The American Society for Colposcopy and Cervical Pathology