Septic arthritis of the sternomanubrial joint due to Pseudomonas pseudomallei

Arthroscopic Management of a Rare Case of Melioidotic Septic Arthritis of the Ankle in a New Endemic Area on the Southwest Coast of India: A Case Report

CASE

We report a case of melioidotic septic arthritis of the ankle and secondary osteomyelitis of the talus in a 64-year-old farmer with diabetes mellitus. Arthroscopic drainage and debridement, followed by 6 months of appropriate antibiotic therapy, resulted in a good short-term outcome.

CONCLUSION

Melioidotic septic arthritis of the ankle is extremely rare. This case report highlights the possibility of this disease occurring on the Indian subcontinent.

Septic arthritis caused by Burkholderia pseudomallei: case report and review of the literature

We describe a case of septic arthritis and bacteremia caused by Burkholderia pseudomallei, a bacterium that is endemic in East Asia and northern Australia. We believe that dissemination occurred in our patient after surgical excision of a pulmonary nodule. Bacteremic melioidosis can present with musculoskeletal involvement in 2-10% of patients, but septic arthritis is uncommon. A review of the literature shows a total of 66 patients reported with septic arthritis caused by this organism. Patients with septic arthritis caused by Burkholderia pseudomallei were likely to have diabetes mellitus, and the knee is the joint most frequently affected by this organism. Recommended initial treatment consists of ceftazidime, alone or in combination with trimethoprim/sulfamethoxazole, high dose imipenem/cilastatin, or high dose cefoperazone/sulbactam. This is followed by a 12-20 week course of oral therapy (based on susceptibilities) to eradicate the organism. Most patients with subacute or latent disease do well after full antibiotic treatment, but relapses are common if full treatment is not given. Awareness of this disease is important even in areas outside of Asia given the increasing frequency of international travel and the growing likelihood of imported cases, along with an aging population of Vietnam veterans and immigrants.

Septic arthritis of the manubriosternal joint

Pyarthrosis of the manubriosternal joint is exceedingly rare. Its rarity defies an early diagnosis, and other causes of chest pain would normally be ruled out first. We describe a patient with a short history of chest pain, pyrexia, and raised inflammatory markers. A destroyed manubriosternal joint with a large abscess was found during surgical exploration. This case illustrates an unusually rapid development of septic arthritis involving a fibrocartilaginous joint in an otherwise healthy young man. Nine other cases have been described in the literature and are reviewed. Early diagnosis followed by adequate surgical drainage and antibiotic therapy led to a good outcome.

Chronic sternal osteomyelitis complicating primary manubriosternal septic arthritis

We present a 40-year-old woman complaining of worsening chest pain. She was previously treated with a prolonged course of antibiotics for suspected sternal osteomyelitis. Radiological investigations were suggestive of ongoing inflammation within the manubriosternal joint. Formal surgical debridement yielded evidence corroborating the diagnosis although microbiological samples were negative. Prolonged empirical treatment with intravenous antibiotics leads to a complete resolution of symptoms. Primary culture-negative manubriosternal septic arthritis is rare, and suboptimal treatment, particularly if confused with other conditions such as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, compounds its considerable morbidity.

Musculoskeletal melioidosis: clinical and imaging features

OBJECTIVE

Melioidosis is a tropical infection caused by a gram-negative bacillus, Pseudomonas pseudomallei. The disease manifests initially as localized suppurative lesions and can progress to acute disseminated septicemia with 65-90% mortality if inadequately treated. Musculoskeletal involvement is common. The purpose of this study was to describe the clinical features and imaging appearances of musculoskeletal melioidosis.

DESIGN

We retrospectively analyzed the clinical profiles and images of 26 patients diagnosed over a 6-year period as suffering from melioidosis.

PATIENTS

The study group comprised 11 patients with musculoskeletal melioidosis and 15 patients with nonmusculoskeletal melioidosis.

RESULTS AND CONCLUSIONS

We found that musculoskeletal melioidosis mimicks other infections both clinically and radiologically. Clinical awareness is therefore crucial, as diagnosis can only be established by bacteriological and immunological studies. Prompt treatment with long-term combination antibiotics in high dosages and surgical drainage of abscesses improves survival.

Thymic abscess with bacteremia and manubriosternal pyarthrosis in a geriatric patient

We describe a geriatric patient with acute substernal chest pain thought to be due to coronary heart disease, who was subsequently found to have Staphylococcus aureus bacteremia associated with infection of the thymus and manubriosternal joint. To our knowledge, this is the first report of (1) a thymic abscess in a geriatric patient, (2) a thymic abscess associated with bacteremia, (3) extra-articular extension of manubriosternal pyarthrosis, and (4) manubriosternal pyarthrosis in the geriatric age group.

Septic manubriosternal arthritis in a patient with Reiter's disease

A man with a quiescent Reiter's disease presented with abrupt upper chest pain. This symptom resulted from a septic arthritis of the manubriosternal joint due to staphylococcus aureus cultured from the synovial fluid.

Pseudomonas pseudomallei infection from drowning: the first reported case in Taiwan

We report a case of Pseudomonas pseudomallei infection, in which the patient acquired the bacteria by aspiration of river water after a drowning incident near Manila, the Philippines. The pulmonary form of melioidosis was noted at the onset, but septicemia developed at a later stage. Positive blood cultures were obtained 17 days after the accident. The patient was treated successfully with a combination of amikacin and cephalothin. This is the first report of P. pseudomallei infection documented in Taiwan.

Epididymo-orchitis due to Pseudomonas pseudomallei

We report the first case of epididymo-orchitis caused by Pseudomonas pseudomallei. The diagnosis was made by isolation of the organism from testicle pus and urine. Treatment was successful with chloramphenicol and co-trimoxazole.