Post-partum septic arthritis of the knee: a case report

Rare case of postpartum septic arthritis of the shoulder caused by multi-drug resistant Kingella kingae: A case report

INTRODUCTION

Septic arthritis is a severe joint infection that can cause permanent damage if not promptly treated. Although the shoulder is an uncommon site for this condition, Kingella kingae, typically associated with pediatric infections, can occasionally be a causative agent. Postpartum septic arthritis is rare, making this case particularly unique.

PRESENTATION OF CASE

We report a case of a 28-year-old woman who developed severe pain, swelling, and restricted movement in her left shoulder three weeks postpartum. Septic arthritis due to multi-drug resistant Kingella kingae was diagnosed via PCR analysis of the synovial fluid. The patient was successfully managed with intravenous antibiotics and arthroscopic drainage.

DISCUSSION

This case represents a rare instance of postpartum septic arthritis of the shoulder caused by Kingella kingae. The unusual presentation highlights the importance of considering septic arthritis in postpartum women presenting with shoulder pain, even without typical risk factors. The multi-drug resistance observed in this strain underscores the necessity for comprehensive antibiotic susceptibility testing and individualized treatment strategies.

CONCLUSION

This case demonstrates that successful management of postpartum septic arthritis caused by Kingella kingae can be achieved through early diagnosis, targeted antibiotic therapy, and minimally invasive surgical intervention. It emphasizes the importance of a multidisciplinary approach, thorough diagnostic evaluation, and heightened clinical suspicion in postpartum women with shoulder pain to prevent long-term complications.

Septic arthritis of the shoulder due to Ureaplasma urealyticum after emergency caesarean section: a case report

Background

Ureaplasma urealyticum is an intra-cellular bacterium frequently found colonizing the genital tract. Known complications include localized infections, which can result in premature deliveries. Septic arthritis due to U. urealyticum in healthy patients is exceptionally rare, although opportunistic septic arthritis in agammaglobulinemic patients have been reported. However, there are no reports of septic arthritis due to U. urealyticum following caesarean section or in the post-partum period.

Case presentation

A 38-year-old immunocompetent woman presented with severe right shoulder pain, 1 month following emergency caesarean section at 26 weeks of gestation for pre-eclampsia and spontaneous placental disruption with an uncomplicated post-operative recovery.

Our suspicion of septic arthritis was confirmed with abundant pus following arthrotomy by a delto-pectoral approach. Awaiting culture results, empirical antibiotic treatment with intravenous amoxicilline and clavulanic acid was initiated. In spite of sterile cultures, clinical evolution was unfavorable with persistent pain, inflammation and purulent drainage, requiring two additional surgical débridement and lavage procedures.

The 16S ribosomal RNA PCR of the purulent liquid was positive for U. urealyticum at 2.95 × 10⁶ copies/ml, specific cultures inoculated a posteriori were positive for U. urealyticum. Levofloxacin and azithromycine antibiotherapy was initiated. Susceptibility testing showed an intermediate sensibility to ciprofloxacin and clarithromycin. The strain was susceptible to doxycycline. Following cessation of breastfeeding, we started antibiotic treatment with doxycycline for 4 weeks. The subsequent course was favorable with an excellent functional and biological outcome.

Conclusions

We report the first case of septic arthritis due to U. urealyticum after caesarean section. We hypothesize that the breach of the genital mucosal barrier during the caesarean section led to hematogenous spread resulting in purulent septic arthritis. The initial beta-lactam based antibiotic treatment, initiated for a purulent arthritis, did not provide coverage for cell wall deficient organisms. Detection of 16S rRNA allowed for a correct microbiological diagnosis in a patient with an unexpected clinical course.