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Rodriguez-Quick VA, Llop A, Dimas K, Girgawy EA. MRSA in the bursa: an unusual complication of MRSA bacteremia causing bilateral acromioclavicular septic arthritis. Access Microbiol 2022; 4:acmi000438. [PMID: 36644736 PMCID: PMC9836058 DOI: 10.1099/acmi.0.000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background. Bacteraemia is known to cause serious complications including metastatic infections such as infective endocarditis, vertebral osteomyelitis, iliopsosas abscesses and septic arthritis. Bilateral septic arthritis, however, is a rare medical emergency with limited previous reports. Staphylococcus species are the most common organisms identified as a result of suspected haematogenous spread from bacteraemia, direct inoculation or translocation from adjacent tissues. While unilateral septic arthritis due to intravenous drug use is a common phenomenon warranting prompt treatment to preserve mobility, function and quality of life, cases of bilateral infections are exceedingly rare. Furthermore, infections involving the acromioclavicular joint are not commonly documented in the literature. Case Presentation. We present a case of a 41-year-old female with a history of intravenous drug use who presented with low back pain and was found to have methicillin-resistant Staphylococcus aureus bacteraemia that was complicated with metastatic infections causing bilateral acromioclavicular joint septic arthritis. Conclusions. Metastatic infections from bacteraemia are serious complications that can lead to septic arthritis. Though septic arthritis is best known in previous case reports to present as a unilateral infection, rare cases of bilateral involvement warrant further consideration. A thorough history and physical examination evaluating all joints can identify such atypical presentations. Septic arthritis remains a medical emergency, and it is imperative that clinicians recognize unusual presentations to avoid delays in treatment that can lead to detrimental impacts to quality of life.
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Affiliation(s)
- Victoria A. Rodriguez-Quick
- HCA Houston Healthcare Kingwood 22999, US-59 N Kingwood, TX 77339, USA,University of Houston College of Medicine, 4349 Martin Luther King Blvd, Houston, TX 77004, USA,*Correspondence: Victoria A. Rodriguez-Quick,
| | - Alexander Llop
- HCA Houston Healthcare Kingwood 22999, US-59 N Kingwood, TX 77339, USA,University of Houston College of Medicine, 4349 Martin Luther King Blvd, Houston, TX 77004, USA
| | - Kevin Dimas
- HCA Houston Healthcare Kingwood 22999, US-59 N Kingwood, TX 77339, USA,University of Houston College of Medicine, 4349 Martin Luther King Blvd, Houston, TX 77004, USA
| | - Essam A. Girgawy
- HCA Houston Healthcare Kingwood 22999, US-59 N Kingwood, TX 77339, USA,University of Houston College of Medicine, 4349 Martin Luther King Blvd, Houston, TX 77004, USA
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Saha B, Young K, Kahili-Heede M, Lim SY. Septic Arthritis of the Right Wrist Due to Mycobacterium avium Complex in an Immunocompetent Patient. Cureus 2021; 13:e17129. [PMID: 34532171 PMCID: PMC8436997 DOI: 10.7759/cureus.17129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/15/2022] Open
Abstract
Septic arthritis due to Mycobacterium avium complex (MAC) is extremely rare. While MAC infection is classically associated with HIV/AIDS and immunosuppressed states, it may occur in immunocompetent individuals. We report a case of MAC septic arthritis of a native wrist joint in an immunocompetent host. The diagnosis of septic arthritis due to MAC is commonly delayed and initially misdiagnosed, warranting a high level of suspicion to make an accurate and timely diagnosis. Suspecting the diagnosis when there are atypical features present in the clinical history may be crucial in identifying affected patients.
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Affiliation(s)
- Bibek Saha
- Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Kurtis Young
- Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Melissa Kahili-Heede
- Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Sian Yik Lim
- Rheumatology, Pali Momi Medical Center, Aiea, USA
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Saha B, Young K, Kahili-Heede M, Lim SY. Septic arthritis of native joints due to Mycobacterium avium complex: A systematic review of case reports. Semin Arthritis Rheum 2021; 51:813-818. [PMID: 34153895 DOI: 10.1016/j.semarthrit.2021.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/09/2021] [Accepted: 05/31/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION While MAC native joint septic arthritis is historically considered a rare entity, the number of reported cases have increased in recent decades. However, no comprehensive review of this topic has been conducted. OBJECTIVES To conduct a systematic review of cases of MAC native joint septic arthritis reported in the literature and summarize the presentations, baseline characteristics, risk factors, diagnosis, treatment, and treatment outcomes. METHODS A systematic review was conducted by performing an extensive literature search through Medline, Google Scholar, and Web of Science, starting from their inception. Screening of articles, assessment of eligibility, and data synthesis from eligible articles were independently performed by two reviewers with input from a third reviewer to achieve consensus. Inclusion criteria to determine eligibility included articles in English, case reports/case series, adult patients who presented with MAC/MA/MI septic arthritis of a native joint. Statistical analyses were performed using Statistical Package for the Social Sciences. RESULTS Thirty-three cases of MAC native joint septic arthritis were reported since 1976. MAC septic arthritis affects immunocompetent and immunocompromised patients, most frequently as a monoarthritis involving the knees and wrist. MAC septic arthritis may present in the context of disseminated MAC infection and primary MAC septic arthritis. The average time to diagnosis from onset of symptoms was 20 months, where the majority of cases were initially misdiagnosed. Although arthrocentesis can be used to make the diagnosis, a synovial biopsy is necessary in many cases to confirm the diagnosis. A combination of surgery and antimycobacterial drug treatment has the highest chance of achieving complete resolution. CONCLUSION The diagnosis of septic arthritis of native joints due to MAC can be challenging and/or delayed. A high level of suspicion is needed in high-risk patients and also when atypical presentations occur. Therefore, understanding the presentation, risk factors, and pitfalls in diagnosing MAC septic arthritis are essential. MAC septic arthritis literature is scarce, necessitating further research of this rare condition to increase awareness, diagnostic accuracy and determine the optimal treatment strategy to improve patient outcomes.
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Affiliation(s)
- Bibek Saha
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu HI, USA
| | - Kurtis Young
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu HI, USA
| | - Melissa Kahili-Heede
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu HI, USA
| | - Sian Yik Lim
- Pali Momi Medical Center, Hawai'i Pacific Health, 98-1079 Moanalua Road, Suite 300, Aiea, Honolulu 96701, HI, USA.
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Abstract
The purpose of this article is to describe the imaging appearance, etiology, clinical features, and treatment of rare presentations of common bone and joint diseases known to mimic Hill-Sachs lesions. Knowledge of uncommonly encountered manifestations of ankylosing spondylitis, rheumatoid arthritis, septic joint, hyperparathyroidism, hydroxyapatite deposition disease, malignant bone tumors, and benign bone cysts which mimic traumatic Hill-Sachs lesions is important for radiologists to guide the clinical care of patients who present with shoulder symptoms.
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Affiliation(s)
- Allison Herring
- Department of Diagnostic Radiology and Nuclear Medicine, 21668University of Maryland Medical Center, Baltimore, MD, USA
| | - Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, 21668University of Maryland School of Medicine, Baltimore, MD, USA
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Vrettos A, Prasinou M, Ahmad E, Malamis D, Khan A. Mycobacterium avium-intracellulare septic arthritis of the sternoclavicular joint in an immunocompetent host; a three-year follow-up. ACTA ACUST UNITED AC 2019; 66:422-426. [DOI: 10.1016/j.ijtb.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/17/2018] [Indexed: 12/01/2022]
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Monoartritis séptica erosiva y osteomielitis de la muñeca por Mycobacterium intracellulare en un paciente inmunocompetente. Med Clin (Barc) 2017; 149:44-45. [DOI: 10.1016/j.medcli.2017.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
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Abstract
Despite the ubiqitous nature of Mycobacterium avium complex (MAC) organisms in the environment, relatively few of those who are infected develop disease. Thus, some degree of susceptibility due to either underlying lung disease or immunosuppression is required. The frequency of pulmonary MAC disease is increasing in many areas, and the exact reasons are unknown. Isolation of MAC from a respiratory specimen does not necessarily mean that treatment is required, as the decision to treatment requires the synthesis of clinical, radiographic, and microbiologic information as well as a weighing of the risks and benefits for the individual patient. Successful treatment requires a multipronged approach that includes antibiotics, aggressive pulmonary hygiene, and sometimes resection of the diseased lung. A combination of azithromycin, rifampin, and ethambutol administered three times weekly is recommend for nodular bronchiectatic disease, whereas the same regimen may be used for cavitary disease but administered daily and often with inclusion of a parenteral aminoglycoside. Disseminated MAC (DMAC) is almost exclusively seen in patients with late-stage AIDS and can be treated with a macrolide in combination with ethambutol, with or without rifabutin: the most important intervention in this setting is to gain HIV control with the use of potent antiretroviral therapy. Treatment outcomes for many patients with MAC disease remain suboptimal, so new drugs and treatment regimens are greatly needed. Given the high rate of reinfection after cure, one of the greatest needs is a better understanding of where infection occurs and how this can be prevented.
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Christ AB, Zininberg EV, Jules-Elysee KM, Parks ML. Mycobacterium avium Complex Septic Arthritis Presenting as Osteonecrosis of the Femoral Head in a Patient With Systemic Lupus Erythematosus. Orthopedics 2017; 40:e549-e552. [PMID: 28056158 DOI: 10.3928/01477447-20161229-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
Mycobacterium avium complex is a rare cause of musculoskeletal infection, usually occurring in patients with compromised immune systems. Obtaining the diagnosis requires a high index of suspicion, and treatment can be delayed because of difficulty with isolating the organism. Treatment involves prolonged, targeted combination antibiotic therapy, and it is unclear whether eradication of the infection can occur in the presence of a foreign body, such as antibiotic spacers. The authors report a case of M avium infection presenting as presumed osteonecrosis of the femoral head in a young woman with systemic lupus erythematosus. She presented with collapse of her femoral head coinciding with several months of progressive, debilitating hip pain. She had mild fevers during that time, but results from multiple infectious workups, including hip aspiration, were negative. Purulent fluid was found in the operating room, but diagnosis was delayed for 5 weeks while waiting for cultures. The patient required 3 subsequent operations, eventually being left with a resection arthroplasty. Pertinent issues concerning diagnosis, therapy, and treatment challenges in M avium infections of the musculoskeletal system are discussed in this case report. [Orthopedics. 2017; 40(3):e549-e552.].
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Coexistent Pseudogout and Mycobacterium avium-intracellulare Septic Arthritis in a Patient with HIV and ESRD. Case Rep Rheumatol 2016; 2016:5495928. [PMID: 27803833 PMCID: PMC5075596 DOI: 10.1155/2016/5495928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/28/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022] Open
Abstract
Pseudogout is a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in synovial fluid, menisci, or articular cartilage. Although not very common, this entity can be seen in patients with chronic kidney disease (CKD). Septic arthritis due to Mycobacterium avium-intracellulare (MAI) is a rare entity that can affect immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS) or those who are on immunosuppressive drugs. Here, we describe a 51-year-old female who presented with fever, right knee pain, swelling, warmth, and decreased range of motion for several days. The initial assessment was consistent with pseudogout, with negative bacterial and fungal cultures. However, due to high white blood cell (WBC) count in the synovial fluid analysis, she was empirically started on intravenous (IV) vancomycin and piperacillin-tazobactam and discharged on IV vancomycin and cefepime, while acid-fast bacilli (AFB) culture was still in process. Seventeen days later, AFB culture grew Mycobacterium avium-intracellulare (MAI), and she was readmitted for relevant management. This case illustrates that septic arthritis due to MAI should be considered in the differential diagnosis of septic arthritis in immunocompromised patients.
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Bilateral and simultaneous septic arthritis of the acromioclavicular joint in an immunocompromised patient: a case report and review of the literature. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Bacteria, viruses, fungi, and parasites can all cause arthritis of either acute or chronic nature, which can be divided into infective/septic, reactive, or inflammatory. Considerable advances have occurred in diagnostic techniques in the recent decades resulting in better treatment outcomes in patients with infective arthritis. Detection of emerging arthritogenic viruses has changed the epidemiology of infection-related arthritis. The role of viruses in the pathogenesis of chronic inflammatory arthritides such as rheumatoid arthritis is increasingly being recognized. We discuss the various causative agents of infective arthritis and emphasize on the approach to each type of arthritis, highlighting the diagnostic tests, along with their statistical accuracy. Various investigations including newer methods such as nucleic acid amplification using polymerase chain reaction are discussed along with the pitfalls in interpreting the tests.
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Affiliation(s)
- Ashish Jacob Mathew
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
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Bilateral Acromioclavicular Septic Arthritis as an Initial Presentation of Streptococcus pneumoniae Endocarditis. Case Rep Infect Dis 2014; 2014:313056. [PMID: 24987538 PMCID: PMC4058585 DOI: 10.1155/2014/313056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/15/2014] [Indexed: 12/11/2022] Open
Abstract
Infective endocarditis (IE) is infrequently associated with septic arthritis. Moreover, septic arthritis of the acromioclavicular (AC) joint is rarely reported in the literature. We report a case of Streptococcus pneumoniae IE in a patient who presented with bilateral AC joint septic arthritis and we review the literature on the topic.
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Abstract
STUDY DESIGN Prospective single-cohort study. OBJECTIVES To determine and document changes in pain and disability in patients with primary, nonacute acromioclavicular joint (ACJ) pain treated with a manual therapy approach. BACKGROUND To our knowledge, there are no published studies on the physical therapy management of nonacute ACJ pain. Manual physical therapy has been successful in the treatment of other shoulder conditions. METHODS The chief inclusion criterion was greater than 50% pain relief with an ACJ diagnostic injection. Patients were excluded if they had sustained an ACJ injury within the previous 12 months. Treatment was conducted utilizing a manual physical therapy approach that addressed all associated impairments in the shoulder girdle and cervicothoracic spine. The primary outcome measure was the Shoulder Pain and Disability Index. Secondary measures were the American Shoulder and Elbow Surgeon and global rating of change scales. Outcomes were collected at baseline, 4 weeks, and 6 months. The Shoulder Pain and Disability Index and American Shoulder and Elbow Surgeon scale values were analyzed with a repeated-measures analysis of variance. RESULTS Thirteen patients (11 male; mean ± SD age, 41.1 ± 9.6 years) completed treatment consisting of an average of 6.4 sessions. Compared to baseline, there was a statistically significant and clinically meaningful improvement for the Shoulder Pain and Disability Index at 4 weeks (P = .001; mean, 25.9 points; 95% confidence interval [CI]: 11.9, 39.8) and 6 months (P<.001; mean, 29.8 points; 95% CI: 16.5, 43.0), and the American Shoulder and Elbow Surgeon scale at 4 weeks (P<.001; mean, 27.9 points; 95% CI: 14.7, 41.1) and 6 months (P<.001; mean, 32.6 points; 95% CI: 21.2, 43.9). CONCLUSION Statistically significant and clinically meaningful improvements were observed in all outcome measures at 4 weeks and 6 months, following a short series of manual therapy interventions. These results, in a small cohort of patients, suggest the efficacy of this treatment approach but need to be verified by a randomized controlled trial. LEVEL OF EVIDENCE Therapy, level 4.
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Wang SX, Yang CJ, Chen YC, Lay CJ, Tsai CC. Septic arthritis caused by Mycobacterium fortuitum and Mycobacterium abscessus in a prosthetic knee joint: case report and review of literature. Intern Med 2011; 50:2227-32. [PMID: 21963746 DOI: 10.2169/internalmedicine.50.5610] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Nontuberculous mycobacterium (NTM) is an infrequent cause of prosthetic knee joint infections. Simultaneous infection with different NTM species in a prosthetic knee joint has not been previously reported. A case of prosthetic knee joint infection caused by Mycobacterium abscessus and M. fortuitum is described in this report. The patient was successfully treated with adequate antibiotics and surgery. The clinical features of sixteen previously reported cases of prosthetic knee joint infection caused by NTM are reviewed.
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Affiliation(s)
- Shu-Xiang Wang
- Department of Radiology, Buddhist Dalin Tzu Chi General Hospital, Taiwan, ROC
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Iyengar KP, Gudena R, Chitgopkar SD, Ralte P, Hughes P, Nadkarni JB, Loh WYC. Primary septic arthritis of the acromio-clavicular joint: case report and review of literature. Arch Orthop Trauma Surg 2009; 129:83-6. [PMID: 18810473 DOI: 10.1007/s00402-008-0747-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Indexed: 11/24/2022]
Abstract
Primary septic arthritis of the Acromio clavicular joint is an uncommon disorder and is rarely seen even in an immunocompromised individual. We report a case of primary septic arthritis of the acromio-clavicular (A-C) joint caused by Staphylococcus aureus without any predisposing factors. The patient was admitted with left shoulder pain, restricted movements and fever. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Blood cultures were positive for Staphylococcus-aureus. Magnetic resonance imaging (MRI) using Gadolinium enhancement revealed marked effusion in the A-C joint. Aspiration from the A-C joint revealed a heavy growth of Staphylococcus-aureus. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection and return to full function.
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Affiliation(s)
- Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Town Lane, Kew, Southport, PR8 6PN, UK
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Mathews CJ, Weston VC, Kingsley GH, Coakley G. Future management of septic arthritis. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17460816.3.1.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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