Bilateral thigh pain after treatment for prostate cancer.

To cite: Trubiano JA, Yang N, Mahony AA. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013008784 DESCRIPTION A 78-year-old man presented with 6 weeks’ debilitating thigh, groin and gluteal pain, weight loss and morning stiffness in the absence of fevers. His history was significant for prostate cancer (T1N0M0) treated initially by brachytherapy in 2001 and then transurethral resection of the prostate (TURP) in 2003. Plain x-ray of hips and pelvis, rheumatological screening and creatine kinase were normal while his C reactive protein (CRP) was 83 mg/l (N<5 mg/l). Ongoing symptoms prompted a CT scan of his abdomen and pelvis (figure 1). The CT demonstrated bilateral adductor compartment collections (figure 1A). A CT cystogram (figure 1B) demonstrated a sinus track towards the adductor regions bilaterally with associated pubic symphysis osteomyelitis. A cystoprostatectomy with ileal conduit diversion confirmed pubic symphysis osteomyelitis and necrotic prostate that cultured Candida albicans and Pseudomonas aeruginosa. Postoperatively, he required a 6-week intravenous antibiotic course followed by a 3-month oral antibiotic tail. He has remained well off the antibiotic therapy. Pubic symphysis osteomyelitis arising from a fistulous communication after urological surgery or instrumentation has been reported in the literature, predominately as an acute presentation, often years following the initial management. Chronic pubic symphysis osteomyelitis with bilateral adductor abscesses is rarely reported. Unilateral and bilateral thigh abscesses have been reported following female incontinence surgery and transurethral resection of the prostate. Thigh abscess formation predominately occurs acutely, unilaterally, secondary to haematogenous osteomyelitis or gyaneocological procedures. Readers should be aware that abscess development may occur years after prostate cancer treatment and that the presentation may be indolent.