Case Report: Polyarticular Septic Arthritis with Septic Shock in a Non-immunocompromised Individual
2Infectious Diseases Unit and Faculty of Health Sciences, Soroka University Medical Center and Ben Gurion University of the Negev, Israel
Septic arthritis (SA) is an orthopedic emergency that can lead to significant morbidity and mortality. Polyarticular involvement is relatively rare, underdiagnosed and occurs primarily in immunocompromised hosts.
We report a 56-year-old patient with no chronic illnesses, presented to the emergency department in septic shock with an episode of SA.
Two weeks prior to the current admission she complained respiratory distress and a productive yellowish-green cough followed by low grade fever and worsening pain of her right shoulder, and on the next day left knee pain and swelling.
On admission she had low blood pressure and tachycardia. Physical examination revealed two joints with suspected arthritis- right shoulder and left knee. Joint aspiration was performed with purulent effusion from both sites. Synovial fluid analysis was consistent with SA. Total body CT scan revealed a mild left pleural effusion and consolidation of the left lower lobe.
After initial management she was taken to the Operating room and arthroscopic irrigation and debridement was performed for both joints, tissue and synovial fluid were sent for culturing.
All cultures results were positive for Streptococcus pneumonia. antibiotic treatment was changed to intravenous ceftriaxone and oral doxycycline.
Workup for the origin of infection did not reveal another source of infection other than Pneumoniae.
Overall, the patient was treated with IV Ceftriaxone and PO Doxycycline for six weeks followed by another month of oral Doxycycline Amoxicillin.
Swelling and tenderness of the Rt Shoulder and Lt Knee as well as pain and range of motion gradually improved. C-reactive protein (CRP) declined during her hospitalization from 99 mg/dL on admission to 12.7 mg/dL on discharge. On her outpatient follow-up the knee was painless with full range of motion but she still suffered from mild shoulder pain, though she has no signs of active infection including CRP within normal range (0.5 mg/dL).