Groin pain in the post-radiotherapy pelvis – have you considered osteomyelitis?

A man in his eighties presented to the Emergency Department with a 5-week history of lower abdominal
and groin pain which had substantially affected his mobility. He practised intermittent selfcatheterisation following radiotherapy for prostate cancer. Multiple suggestive features led to initial treatment for a urinary tract infection (UTI). However, CT imaging revealed pubic symphysis osteomyelitis with associated abdominal wall abscesses and fistulation to the prostate. This case illustrates the need to consider osteomyelitis as a differential for pain in previously irradiated body areas and to beware of diagnosing UTI where pain affects mobility.