Beyond Pneumonia: A Rare Case of Pericardial Empyema Caused by Streptococcus pneumoniae

Purulent pericardial effusion is a rare but potentially deadly condition that demands immediate medical attention. When left untreated, it can have catastrophic consequences. While bacterial infection is the most common cause of this condition, it usually occurs in individuals with weakened immune systems or in those undergoing dialysis or thoracic surgery. This case report presented here is unique as it chronicles the uncommon experience of a 58-year-old male with a normally functioning immune system who suffered from purulent pericardial effusion, endocarditis, and pneumonia, all linked to septic arthritis of his knee caused by Streptococcus pneumoniae. The diagnosis and management of this condition require a swift and comprehensive approach, and any delay in treatment can have dire outcomes. This case highlights the significance of early detection and prompt treatment of purulent pericardial effusion to prevent severe complications and improve patient prognosis.

Bilateral Knee Septic Arthritis in a Seven-Month-Old Girl

Septic arthritis (SA) is a type of joint inflammation caused by an infection. It is an orthopedic emergency that requires immediate treatment to avoid serious complications such as joint destruction, osteomyelitis, and sepsis. We present a case of bilateral knee SA in a seven-month-old female who presented to our emergency department with left knee SA, followed by right knee SA one month later.

A Retrospective Review of Native Septic Arthritis in Patients: Can We Diagnose Based on Laboratory Values?

Introduction The accurate diagnosis of acute septic arthritis is essential to initiating appropriate treatment and minimizing potential cartilage damage. A synovial fluid cell count of 50,000 cells/mm³ has been used as a diagnostic cutoff for acute septic arthritis, although data supporting this is lacking. The purpose of this study was to assess the efficacy of synovial cell counts to predict septic arthritis in patients with symptomatic native joints. Methods A retrospective review was performed of patients who were evaluated for septic arthritis at a single institution with the use of synovial fluid analysis and adjunctive lab tests. Exclusion criteria included history of a total joint arthroplasty of the affected joint or immunocompromised state. A true infection was considered on the basis of positive or negative synovial aspirate cultures. We evaluated the synovial cell count, synovial polymorphonuclear cell percentile (% neutrophils), serum white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in order to determine their association and predictive power in a true infection. Results Of the 65 patients included in the study, 40 (61.5%) had a positive culture for septic arthritis and 25 (38.5%) had negative cultures. Patients with positive cultures had a larger median % neutrophils than patients with negative cultures (median: 93 vs. median: 86, P=0.041). They also tended to have higher serum CRP levels compared to negative culture patients (median: 142.30 vs. 34.20, P=0.051). No outcomes were independently highly effective in discriminating between patient groups (area under the curve (AUC) ≤ 0.67). There was no significant difference between the synovial cell counts in patients with culture positive septic arthritis and patients with negative cultures (median: 32435 vs 35385, P = 0.94).  Conclusion Patients with culture proven septic arthritis had larger % neutrophils. However, there were no other statistically significant differences between patient groups regarding ESR, CRP, WBC, or cell count aspiration at the time of diagnosis. No synovial cell count level was highly effective in discriminating patients with a positive culture for septic arthritis from patients with negative cultures.