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Panminerva Medica 2002 June;44(2):151-4

lingua: Inglese

Pneumococcal septic arthritis of the shoulder. Case report and literature review

Bertone C., Rivera F., Avallone F., Urgelli S., Maniscalco P.

From the Department of Radiological and Orthopaedic - Rehabilitative Sciences Orthopaedic and Traumatologic Clinic University of Siena, Siena, Italy


Septic ­arthritis due to Streptococcus Pneumoniae ­appears to be rel­a­tive­ly uncom­mon. Single- or clus­tered-­case his­to­ries con­sti­tute the major­ity of ­reports on pneu­mo­coc­cal sep­tic ­arthritis. A 70-­year-old man pre­sent­ed ­with a 7-day his­to­ry of ­pain, ery­the­ma and swell­ing of the ­left shoul­der. Physical exam­ina­tion of the ­left shoul­der ­revealed a ­warm, swol­len, ery­them­a­tous, and mark­ed­ly ten­der to ­light pal­pa­tion. The ­patient was ­unable to ele­vate his arm ­more ­than 30° with­out ­pain. Arthrocentesis per­formed on admis­sion pro­duced 30 cc of gross­ly puru­lent ­fluid ­whose cul­ture dem­on­strat­ed S. Pneumoniae. The sep­tic ­arthritis was treat­ed ­with intra­ve­nous van­com­y­cin and imip­e­nem. The anti­bi­o­tics ­were sub­sti­tut­ed ­when the sen­si­tiv­ities ­were ­known ­with ­oral cip­ro­flox­a­cin and rifam­py­cin to com­plete 8 ­weeks’ ­total treat­ment. On fol­low-up exam­ina­tion 1 ­year lat­er, the ­patient has ­remained afe­brile and asymp­to­mat­ic with­out evi­dence of increas­ing ­joint effu­sion or ­acute ­joint inflam­ma­tion. Pneumococcal ­arthritis is clas­si­cal­ly ­described as a pain­ful mono­ar­tic­u­lar ­arthritis com­pli­cat­ing an ­active pneu­mo­coc­cal infec­tion, gen­er­al­ly a pri­mary pul­mo­nary infec­tion. Pneumococcal ­arthritis ­appears to be pre­dom­i­nate­ly a dis­ease affect­ing the eld­er­ly. Clinical pres­en­ta­tion rang­es ­from sep­ti­ce­mia to indo­lent infec­tion ­with few system­ic symp­toms. With ade­quate anti­bi­o­tic ther­a­py and aspi­ra­tion or drain­age of the ­joint, the prog­no­sis for ­return of nor­mal ­joint func­tion ­appears to be excel­lent. Although pneu­mo­coc­cal organ­isms are not like­ly caus­es, ­this bac­te­ria ­should cer­tain­ly be con­sid­ered as a pos­sible ­cause of ­arthritis or pros­thet­ic infec­tion.

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