Bacteremia and polyarticular septic arthritis secondary toMoraxella bovisin a pregnant patient with HIV who injects drugs

Abstract

CASE PRESENTATION: We report a rare case of Moraxella bovis bacteremia and polyarticular septic arthritis in a 37-year-old pregnant woman with HIV who injects drugs. Two sets of blood cultures obtained 5 hours apart were positive for gram-negative bacilli, and purulent fluid was present intra-operatively from both her left knee and her right third MCP joints. DIAGNOSIS: Organism identification using ligation sequencing confirmed both her blood culture and synovial tissue isolates as M. bovis. Her infection was initially treated with third-generation cephalosporins and later changed to moxifloxacin because of a drug reaction; although she defervesced clinically with improvement in her C-reactive protein levels, she died most likely as a result of a non-traumatic fat embolism after an elective Caesarean delivery. DISCUSSION: In contrast to Moraxella catarrhalis, other Moraxella species are rarely associated with disease in human hosts. M. bovis is classically associated with infectious bovine keratoconjunctivitis in cattle; interestingly, our patient denied significant animal exposure. To the authors’ knowledge, this is the first case describing infection secondary to M. bovis in an adult host.

Moraxella catarrhalis Septic Arthritis Unveils Undiagnosed Systemic Lupus Erythematous in a Pediatric Patient

“…In case reports of Moraxella septic arthritis, the patients often had a known underlying comorbidity that made them susceptible. Cases included patients with a prosthetic knee joint [18], history of stem cell transplant [16], pregnancy with concurrent HIV and intravenous drug use [19], multiple myeloma [20], post-traumatic injury [21], hemodialysis treatment [21], or immunocompromise after recent treatment with infliximab [22]. Of note, one other case report did show culture-proven Moraxella septic arthritis in a patient with SLE; however, she had recently completed a prednisone taper for an acute lupus flare [23].…”