Introduction: Autonomic dysreflexia is a serious and potentially life-threatening complication of spinal cord injury occurring at T6 or above. It is most often triggered by a sublesional irritative stimulus, typically involving the urinary or gastrointestinal tract.
Although common causes are well recognized, less typical etiologies may complicate the clinical picture.
The hallmark features are arterial hypertension and bradycardia, while associated symptoms may include headache, visual disturbances, dyspnea, nausea, palpitations, nasal congestion, chills, diaphoresis, and flushing.

Case presentation: We report the case of a 46-year-old woman with incomplete tetraplegia at C7, who presented with signs and symptoms of autonomic dysreflexia without an obvious precipitating factor.
Clinical work-up and management of autonomic dysreflexia were initiated.

Results: Imaging studies revealed osteitis of the pubic symphysis associated with a peri-symphysis abscess and bone lysis, following the appearance of a palpable suprapubic mass.

Discussion: Routine follow-up in patients with spinal cord injury includes urodynamic studies, cystoscopy, and ultrasound. In this patient, no conventional risk factors for symphyseal infection were identified, apart from routine urological surveillance procedures.
The etiology of dysreflexia was therefore unusual and its identification unexpected. Antibiotic therapy reduced the episodes of dysreflexia but did not prevent progression of the underlying bone lysis secondary to pubic symphysitis.
A comprehensive etiological assessment is essential in cases of autonomic dysreflexia. Given its potential to endanger life, this condition should always be promptly recognized and appropriately managed.

Autonomic dysreflexia, Osteitis pubis, Pubic symphysis, Spinal cord injuries, Tetraplegia, Spinal cord