Pneumococcal septic arthritis as the initial presentation of multiple myeloma

Abstract

Septic arthritis induced by Streptococcus pneumoniae is an uncommon manifestation of pneumococcal infection. Pneumococcus has been identified as the inciting pathogen in only 6% of cases of septic arthritis in recent retrospective studies (Ross et al., 2003). Approximately 50% of patients with pneumococcal septic arthritis have a preceding or concurrent extra-articular focus of infection. The septic joint evolves from hematogenous seeding of the highly vascular synovial membrane by bacteria. Polyarticular disease occurs in only approximately 36% of patients. Most pneumococcal septic arthritis occurs with coexistant joint disease, prosthesis, alcoholism, HIV infection, or rheumatoid arthritis (Baraboutis & Skoutelis, 2004; Raad & Peacock, 2004). We report a case of polyarticular septic arthritis as the first manifestation of an underlying disease. Our literature review discloses that this is the first reported case of multiple myeloma initially presenting as pneumococcal septic arthritis in the USA and the third internationally (Cuesta et al., 1992; Renou et al., 2007).

Septic polyarthritis caused by Streptococcus pneumoniae: primary pneumococcal pneumonia as a risk factor in older patients? A case report

“…Complex systemic pneumococcal infection with polyarticular manifestation1 – 4 occurs very rarely. There is rising evidence for the perceived frequency of S pneumoniae as a cause for septic arthritis over the last few decades 10.…”

“…Pneumococcal septic polyarthritis is an infrequently reported septic manifestation due to pneumococcal pneumonia 1 – 4. It has been shown that only 1.3% of pneumococcal bacteraemias lead to a manifestation in the ankles 5.…”

Emerging advances in fluorescence imaging and phototherapy of arthritis

“…Respiratory infections with group A hemolytic streptococci have the potential to cause arthritis in immunocompromised conditions. [ 29 ] Infections following bleeding from abrasions at the joint site also carry the risk of further infection of the joint fluid by bacteria coming into contact with the wound site, leading to arthritis. Endogenous bacterial infections mainly include blood‐borne bacteria, medical infections and septic lesions near joints.…”

Mesenteric amyloid deposition as the initial presentation of multiple myeloma

“…The tumourous products, either abnormal immunoglobulins or inflammatory cytokines, may bring about such deleterious effects as renal failure, hyperviscosity syndrome and lytic bone lesions. Increased susceptibility to certain infections is another common manifestation in these patients 1–4. Occasionally, the disease presents with an extramedullary mass consisting of abnormal plasma-cell nests 5.…”