Septic polyarthritis and necrotizing fascitis in an immunocompetent patient. Case report
DOI:
https://doi.org/10.1016/j.rccot.2021.04.009Keywords:
immunocompetent adult, septic arthritis, necrotizing fasciitis, streptococcus pyogenes, polyarticular septic arthritisAbstract
Septic polyarthritis in an immunocompetent patient is highly rare, even more when it coexists with necrotizing fasciitis caused by Streptococcus Pyogenes (SP). A 54 year old, immunocompetent male patient is presented herein. The patient had no relevant previous illness, before the installation of a septic arthritis of both knees and he’s left ankle. He receives treatment with sequential surgical debridement, then develops necrotizing fasciitis of the posterior aspect of the left leg requiring adequate treatment for such condition (including Vacuum Assisted Closure), as well as antibiotic therapy for the specific infecting microorganism (Penicillin + Vancomycin). Nonetheless, after a month of surgical management between Plastic Surgery, Dermatology, Orthopaedics as well as surveillance in the Intensive Care Unit, the patient dies after multi organic failure. Infection caused by SP might entail high morbidity for a patient and even end with death of the aforementioned caused by a hard to manage systemic organic failure. The adequate diagnosis, as well as aggressive medical and surgical management could not be enough for controlling the infection, even in patients without previous immunological compromise. At the same time, a multidisciplinary approach must be the standard of treatment, aiming to control predisposing infectious conditions. This is the first case reported in national literature related to these two fatal conditions. Finally, one of the purposes of this report is to highlight that despite reports of this microorganism infecting infants and immunocompromised patients, it must not be obviated in healthy patients, especially in cases of rapidly spreading infection and scarce response to adequate management. Evidence Level: IVDownloads
References
Soria LM, Marqués AO, Casares EG, Melchor EG, Pérez SH, Marsà XT. Artritis séptica politópica: Análisis de 19 casos. Reumatol Clin. 2009;5:18-22, https://doi.org/10.1016/S1699-258X(09)70199-8
Clements J, Dinneen A, Heilpern G. Polyarticular septic arthritis in an immunocompetent patient. Ann R Coll Surg Engl. 2013;95:10-1. https://doi.org/10.1308/003588413X13511609955292
Soor P, Sharma N, Rao C. Multifocal Septic Arthritis Secondary to Infective Endocarditis: A Rare Case Report. J Orthop case reports. 2017;7:65-8.
Zabsonré JT, Laoubi K, Kemiche F, Cerf-Payrastre I, Pertuiset E. Streptococcus B septic polyarthritis revealing Good's syndrome. Jt Bone Spine. 2012;79:412-4. https://doi.org/10.1016/j.jbspin.2012.03.009
Marti J, Antón E. Polyarticular septic arthritis caused by Streptococcus pyogenes in an immunocompetent woman. Our J Intern Med. 2007;18:6205, https://doi.org/10.1016/j.ejim.2006.05.007
Smolyakov R, Riesenberg K, Schlaeffer F, Borer A, Gilad J, Peled N, et al. Streptococcal septic arthritis and necrotizing fasciitis in an intravenous drug user couple sharing needles. Isr Med Assoc J. 2002;4:302-3.
Ali RA, Kaplan SL, Rosenfeld SB. Polyarticular Septic Arthritis Caused by Haemophilus influenzae Serotype f in an 8-Month-Old Immunocompetent Infant: A Case Report and Review of the Literature. Case Rep Orthop. 2015;2015:163812, https://doi.org/10.1155/2015/163812
Laatiris A, Amine B, Yacoub YI, Hajjaj-Hassouni N. Septic polyarthritis caused by group A streptococcus in an immunocompetent adult: Rare case. Rheumatol Int. 2012;32:2697-700. https://doi.org/10.1007/s00296-011-2029-1
Mcculloch M, Brooks H, Kalantarinia K. Isolated polyarticular septic arthritis: An atypical presentation of meningococcal infection. Am J Med Sci [Internet]. 2008;335:323-6, https://doi.org/10.1097/MAJ.0b013e318142bb0d
Park L, Nelson SB, Turbett SE. Case 29- 2017. N Engl J Med. 2017;377:1189-95, https://doi.org/10.1056/NEJMcpc1706108
Miller A, Abduljabbar F, Jarzem P. Case Report Polyarticular Septic Arthritis in an Immunocompetent Adult: A Case Report and Review of the Literature. case Rep Orthop. 2015;2015:602137, https://doi.org/10.1155/2015/602137
Tang WM, Ho PL, Yau WP, Wong JW, Yip DK. Report of 2 fatal cases of adult necrotizing fasciitis and toxic shock syndrome caused by Streptococcus agalactiae. Clin Infect Dis. 2000;31:E15-7. https://doi.org/10.1086/318148
Umemura H, Hiragushi K, Sasaki S, Doi H, Shiota N, Kabutan K, et al. A male with group B streptococcal necrotizing fasciitis at multiple sites secondary to multifocal septic arthritis. Acta Derm Venereol. 2015;95:614-5. https://doi.org/10.2340/00015555-2015
Wall C, Donnan L. Septic arthritis in children. Aus Fam Physician. 2015;44:213-5.
Puttaswamy MK, Sivashanmugam R, Phillips MJ. Polyarticular septic arthritis after total joint arthroplasty. Fellow in Adult Reconstruction Orthopedics. 2015;3:22-5. https://doi.org/10.4103/2319-2585.152145
Epstein JH, Zimmermann B, Ho G. Polyarticular septic arthritis. J Rheumatol. 1986;13:1105-7.
Dubost JJ, Fis I, Soubrier M, Lopitaux R, Ristori JM, Bussiere JL, et al. Septic arthritis in rheumatoid polyarthritis. 24 cases and review of the literature. Rev Rhum Ed Fr. 1994;61:153-65.
Wang DA, Tambyah PA. Septic arthritis in immunocompetent and immunosuppressed hosts. Best Pract Res Clin Rheumatol. 2015;29:275-89, https://doi.org/10.1016/j.berh.2015.05.008
Hayashi M, Kojima T, Funahashi K, Kato D, Matsubara H, Shioura T, et al. Pneumococcal polyarticular septic arthritis after a single infusion of infliximab in a rheumatoid arthritis patient: A case report. J Med Case Rep. 2012;6:1-5. https://doi.org/10.1186/1752-1947-6-81
Sarinho JCGC, Arcadipane MSES, Menezes GTM, Duarte DFC, Cossermelli W, Aprahamian I. Primary meningococcal polyarthritis in an adult woman. Case Rep Med. 2015;2015:5-7. https://doi.org/10.1155/2015/563672
Lieber SB, Fowler ML, Zhu C, Moore A, Shmerling RH, Paz Z. Clinical characteristics and outcomes in polyarticular septic arthritis. Jt Bone Spine. 2018;85:469-73, https://doi.org/10.1016/j.jbspin.2017.09.001
Balsat M, Galicier L, Wargnier A, Pereyre S, Itzykson R, Zouakh M, et al. Diagnosis of Ureaplasma urealyticum septic polyarthritis by PCR assay and electrospray ionization mass spectrometry in a patient with acute lymphoblastic leukemia. J Clin Microbiol. 2014;52:3456-8. https://doi.org/10.1128/JCM.00963-14
Yombi J, cyr, Belkhir L, Jonckheere S, Wilmes D, Cornu O, Vandercam B, et al. Streptococcus gordonii septic arthritis: two cases and review of literature. BMC Infect Dis [Internet]. 2012;12:1. Available from: BMC Infectious Diseases. https://doi.org/10.1186/1471-2334-12-215
Lifshitz A, Torres JD, Autónoma U, Parra GR, Enrique G, Dolci F, et al. Fascitis necrotizante, miositis y síndrome de choque tóxico secundario a estreptococo del grupo G. Reporte de un caso. Revista Médica del Instituto Mexicano del Seguro Social. 2014;(4.).
Nitoslawski S, McConnell TM, Semret M, Stein MA. A Case of Polyarticular Pasteurella multocida Septic Arthritis. Can J Infect Dis Med Microbiol [Internet]. 2016:1-3, https://doi.org/10.1155/2016/5025697
Whitehead-Clarke TI, Singavarapu R, Gulihar A, Chettiar K. Bilateral, simultaneous pneumococcal septic arthritis of the knees: A normal immune system, an unknown source. BMJ Case Rep. 2016;2016:1-3. https://doi.org/10.1136/bcr-2016-214980
Campanilho-Marques R, Novelli V, Brogan PA, Eleftheriou D. Polyarticular septic arthritis in an 11-year-old child. Clin Rheumatol. 2014;33:1181-2. https://doi.org/10.1007/s10067-014-2496-3
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