Bilateral, simultaneous pneumococcal septic arthritis of the knees: a normal immune system, an unknown source

Abstract

Pneumococcal septic arthritis is a rare clinical entity and is often associated with a systemic bacteraemia. A 60-year-old man was admitted with bilateral swollen, painful knees. He was feeling feverish with raised inflammatory markers. Joint aspiration yielded purulent fluid, which, when cultured, grew Streptococcus Pneumoniae bilaterally. The patient underwent repeated arthroscopic knee washouts and was treated with intravenous (IV) antibiotics. During his admission, various investigations and scans were undertaken to find an infective focus or signs of immunodeficiency; none were found. After 4 weeks of IV antibiotics and 4 knee washouts, the patient was discharged. We believe this is the only case documented of bilateral simultaneous pneumococcal septic arthritis of the knees in an immunocompetent patient with no extra-articular infective focus. This case exemplifies the importance of careful assessment of patients who present with bilateral swollen joints.

Bilateral Simultaneous Streptococcus pneumoniae Knee Septic Arthritis in a Patient with Previous Splenectomy

“…Brzeski et al [1] described the first case of simultaneous bilateral pneumococcal arthritis in a patient with Felty's syndrome who had undergone splenectomy. Whitehead-Clarke et al [2] described the second case of simultaneous pneumococcal bilateral septic arthritis in an immunocompetent patient without any source of infection.…”

Pneumococcal septic arthritis in a patient with mixed connective tissue disease

“…Suele cursar con fiebre y dolor articular, pero los síntomas pueden no manifestarse en inmunodeprimidos y personas de edad avanzada [5] como fue nuestro caso. Además, no siempre es demostrable un foco primario como neumonía [6], de hecho, Ross et al [4] encontraron que hasta en un 50% de los pacientes no se les objetivaba un foco claro. Nuestra paciente no tenía clínica sugerente de otra focalidad.…”