[Septic arthritis as an initial manifestation of a bacterial endocarditis]

Multifocal Septic Arthritis Secondary to Infective Endocarditis: A Rare Case Report

Introduction:

Infective endocarditis (IE) is a rare cause of septic arthritis. We report a patient who presented with multifocal septic arthritis as a result of IE, which is an extremely rare condition.

Case Report:

This 69-year-old gentleman presented to the emergency department (ED) with a 3-day history of acute right knee pain. Initial investigations demonstrated chondrocalcinosis on knee radiographs, acute renal failure with rhabdomyolysis and a CRP of 520. After treatment with intravenous fluid rehydration and analgesia, the knee aspiration grew a Group B Streptococcus, and the patient underwent arthroscopic washout. 48 h after admission the patient developed left wrist and right elbow pain. Further aspirations revealed Group B Streptococcus and the patient underwent further washouts. A multidisciplinary approach was used. Due to ongoing sepsis, an echocardiogram was performed identifying IE. The patient eventually died due to ongoing sepsis and duodenal ulceration.

Conclusion:

This case highlights the importance of considering a systemic cause such as IE for patients presenting with features of multifocal septic arthritis and ensuring all patients undergo a full medical examination as part of the clerking process. Furthermore, it emphasizes the need to adopt a multi-disciplinary approach when presented with complex patients so that the best medical care can be given to prevent morbidity and mortality.