Septic arthritis of the hip joint caused by Klebsiella pneumoniae: a case report

Abstract

Klebsiella pneumoniae is an uncommon cause of septic arthritis in adults. However, late detection can cause serious complications, including joint destruction and immobility. The purpose of this study was to report a case of successfully treated septic arthritis of the hip joint (SAHJ) caused by K. pneumoniae. A 49-year-old female patient presented to our hospital with fever and progressive severe pain in the right hip area. Although there was no abnormality on plain radiographs, ultrasonography revealed diffuse swelling of the right hip joint. Under ultrasonography guidance, the hip joint fluid was aspirated, and Gram staining and culturing were performed. The patient's pain was significantly reduced after the joint aspiration. The Gram staining and culturing revealed gram-negative bacilli, which were subsequently identified as K. pneumoniae. According to the results, systemic intravenous antibiotic (ceftriaxone) was administered without complications, and the patient was discharged on oral antibiotic (ciprofloxacin). Clinical cases of septic arthritis of the knee or sacroiliac joint have been occasionally reported in adults, but cases of SAHJ are rare. Moreover, K. pneumonia-induced SAHJ has not been reported to date. Therefore, we report this very rare case and its successful treatment.

Klebsiella pneumoniae and Enterobacter cloacae Induced Septic Arthritis in a Healthy Adolescent: A Rare Case Report

“…In general, S. aureus is the pathogen most commonly responsible for this complication, while the cause of this lesion can be classified according to age and underlying diseases, such as: K. kingae in children under 2-3 years 4) , Group B Streptococcus , S. aureus , Neisseria gonorrhea , and gram-negative bacilli in infants, N. gonorrhoeae in sexually active adolescents, Salmonella in patients with sickle cell disease, fungal infections in patients who received long-term antibiotic therapy, and Pseudomonas aeruginosa in patients with puncture wounds and injecting drug abusers 3) . K. pneumoniae is a rare cause of SA at any age 6) . SA caused by K. pneumoniae usually occurred after an episode of liver abscesses, pneumonia, and urinary tract infections 19) .…”

“…Different etiologic agents can be considered based on the age group and underlying medical condition 2 3 4) . However, SA is often caused by gram-positive bacteria 6) , particularly Staphylococcus aureus 4) . Klebsiella pneumoniae and Enterobacter cloacae , two gram-negative bacteria, are members of the Enterobacteriaceae family.…”

“…Klebsiella pneumoniae and Enterobacter cloacae , two gram-negative bacteria, are members of the Enterobacteriaceae family. SA caused by K. pneumoniae is an infrequent condition 6) and has only been reported in certain conditions such as trauma, neonates, elderly, intravenous drug abuser, and immunocompromised patients 7) . E. cloacae -associated SA is rare and usually occurred after invasive surgical procedures and traumatic patients 8) .…”

“…SA of the hip joint usually mimics other musculoskeletal diseases such as osteoarthritis exacerbation, psoas tendinopathy, piriformis syndrome, etc. 6 , 7) or tumors like fibrous dysplasia, solitary bone cyst, osteoid osteoma, chondroblastoma, giant cell tumor, osteochondroma, aneurysmal bone cyst, and Langerhans cell histiocytosis 15) ; therefore, diagnosis is a challenge for general orthopedic surgeons or even hip surgeons.…”