Osteomyelitis Pubis in a Diabetic Patient on Sodium-Glucose Cotransporter 2 Inhibitors

Abstract Osteomyelitis pubis, a rare form of osteomyelitis affecting the pubic bone and symphysis, is an often-misdiagnosed condition accounting for less than 1% of all osteomyelitis cases. We present the case of a 41-year-old-male diabetic patient on sodium-glucose-co-transporter-2 (SGLT2) inhibitors, specifically dapagliflozin, who developed osteomyelitis pubis and associated septic arthritis and pyomyositis. Despite a well-controlled diabetes profile and the absence of typical risk factors, the patient's condition progressed rapidly leading to severe pain and functional impairment. Imaging studies revealed extensive infection, and culture results identified Pseudomonas aeruginosa , necessitating a complex, multistage antibiotic regimen. The patient responded positively to treatment but experienced complications, including drug-induced agranulocytosis. This case underscores the potential link between SGLT2 inhibitors and osteomyelitis, highlighting the need for increased clinical vigilance and the careful assessment of risks when prescribing these medications to diabetic patients. Further research is warranted to better understand the association between SGLT2 inhibitors and osteomyelitis pubis.