An unusual case of polyarticular septic arthritis caused by Pseudomonas aeruginosa

Abstract

BACKGROUNDThe most common etiologic agents of septic arthritis (SA) are Gram-positive organisms (e.g., Staphylococcus aureus), with approximately 15% being due to Gram-positive and Gram-negative organisms. Infection by Pseudomonas aeruginosa occurs typically in patients with a history of intravenous drug use, malignancy, prosthetic devices, and advanced age. SA typically affects one joint but may be polyarticular in up to 20% of cases (most commonly in immunocompromised patients). Here we report a case of polyarticular SA caused by P. aeruginosa in a patient with severe chronic comorbidities. CASE REPORTA 45-year-old male patient was admitted to the gastroenterology department due to a week history of fever and joint pain. From comorbidities, he had a diagnosis of ulcerative colitis with primary sclerosing cholangitis (PSC) and had been submitted to liver transplantation in 2012. However, he had recurrence of PSC with several hospitalizations due to progressive liver failure, hepatic encephalopathy, and infectious complications in the last 3 years. The current clinical picture started with fever (39° C) and painful swelling in the right knee with rapid evolution (3 days) to arthritis in the small joints of the hands, wrists, shoulders, and knees. Physical examination revealed intense pain on palpation and swelling in the hands, wrists, elbows, in addition to marked joint blockage in the right knee. Laboratory tests showed increased acute phase reagents (C-reactive protein 244.9 mg/dL) and impaired renal and hepatic functions. He underwent arthrocentesis and joint lavage of the right knee, as well as antibiotic treatment with ceftriaxone (2 g intravenous IV per day) and vancomycin (2 g IV per day). Blood and synovial fluid cultures showed P. aeruginosa multi-S. In this context, antibiotic therapy was optimized according to antibiogram (cephalosporins) Despite the treatment, the patient evolved with rapidly progressive multiorgan dysfunction and an unfavorable outcome with death.