RESUMEN
Austrian syndrome is a rare condition caused by invasive Streptococcus pneumoniae, comprising a triad of pneumococcal meningitis, endocarditis, and pneumonia. Herein, we report a 59-year-old male patient who presented with fever and tenderness of the right shoulder. Although the initial diagnosis was acromioclavicular joint septic arthritis, the present case showed a reduced level of consciousness, pulmonary infiltrates, cerebral infarcts, and destruction of the mitral valve. This case suggests that acromioclavicular joint arthritis could be an initial presentation of pneumococcal infection inclusive of Austrian syndrome, especially in patients with some risk factors of invasive pneumococcal infections, such as chronic alcoholism.
Asunto(s)
Articulación Acromioclavicular/microbiología , Artritis Infecciosa , Endocarditis Bacteriana , Meningitis Neumocócica , Neumonía Neumocócica , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Humanos , Masculino , Meningitis Neumocócica/diagnóstico , Meningitis Neumocócica/tratamiento farmacológico , Meningitis Neumocócica/microbiología , Persona de Mediana Edad , Neumonía Neumocócica/diagnóstico , Neumonía Neumocócica/tratamiento farmacológico , Neumonía Neumocócica/microbiología , Streptococcus pneumoniae , SíndromeRESUMEN
BACKGROUND: Osteoarticular tuberculosis is a great masquerader presenting in varied forms and in atypical locations, and it is prone to misdiagnosis and missed diagnosis. Isolated acromioclavicular joint tuberculosis has been reported rarely. CASE PRESENTATION: A 19-year-old man presented with a chronic, mild pain, non-healing ulcer in right shoulder. Imaging of the shoulder revealed destruction of the acromioclavicular joint and histopathology confirmed the diagnosis of acromioclavicular tuberculosis. The patient underwent debridement, synovectomy and drainage of the abscess and recovered well with antitubercular therapy postoperatively. CONCLUSIONS: Awareness of this uncommon presentation of osteoarticular tuberculosis may assist in earlier diagnosis. Especially, in endemic countries, osteoarticular tuberculosis should be considered as a differential diagnosis in all atypical presentations to avoid residual problems.
Asunto(s)
Articulación Acromioclavicular/microbiología , Tuberculosis Osteoarticular/diagnóstico , Absceso/diagnóstico , Articulación Acromioclavicular/patología , Antituberculosos/uso terapéutico , Desbridamiento , Diagnóstico Diferencial , Drenaje , Humanos , Masculino , Dolor de Hombro/diagnóstico , Dolor de Hombro/tratamiento farmacológico , Dolor de Hombro/microbiología , Dolor de Hombro/cirugía , Tuberculosis Osteoarticular/tratamiento farmacológico , Tuberculosis Osteoarticular/cirugía , Adulto JovenRESUMEN
Coxiella burnetii acromioclavicular infection is a new infectious focus, evidenced here for the first time using the gold standard, culture. Positron emission tomography had a crucial role in identifying the deep infectious focus, even when C. burnetii serological titres were low.
Asunto(s)
Articulación Acromioclavicular/microbiología , Anticuerpos Antibacterianos/sangre , Coxiella burnetii/aislamiento & purificación , Fiebre Q/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Tomografía de Emisión de PositronesRESUMEN
Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.
Asunto(s)
Articulación Acromioclavicular , Artritis Infecciosa/terapia , Piomiositis/terapia , Infecciones Estafilocócicas/terapia , Staphylococcus aureus , Articulación Esternoclavicular , Articulación Acromioclavicular/microbiología , Adulto , Antibacterianos/administración & dosificación , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Femenino , Humanos , Imagen por Resonancia Magnética , Piomiositis/diagnóstico , Piomiositis/microbiología , Infecciones Estafilocócicas/complicaciones , Articulación Esternoclavicular/microbiologíaRESUMEN
Septic arthritis of the acromioclavicular (AC) joint is a rare entity with symptoms that include erythema, swelling, and tenderness over the AC joint, fever, and limitation of shoulder motion with pain. In previous reports, Staphylococcus and Streptococcus species have been mentioned as common causative organisms. Haemophilus parainfluenzae is a normal inhabitant of the oral cavity, respiratory tract, gastrointestinal tract, and urogenital tract. However, it sometimes causes opportunistic infections leading to septic arthritis and osteomyelitis. AC joint infection associated with H.parainfluenzae is very rare, and only one case has been reported in the literature. Moreover, septic arthritis in immunocompetent patients is also very rare. Here, we report the case of a healthy patient with H. parainfluenzae-related septic arthritis of the AC joint.
Asunto(s)
Articulación Acromioclavicular/microbiología , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Infecciones por Haemophilus/tratamiento farmacológico , Infecciones por Haemophilus/microbiología , Haemophilus parainfluenzae , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico , Infecciones por Haemophilus/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Infecciones Oportunistas , Osteomielitis , Dolor de HombroRESUMEN
Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.
Asunto(s)
Adulto , Femenino , Humanos , Articulación Acromioclavicular/microbiología , Antibacterianos/administración & dosificación , Artritis Infecciosa/diagnóstico , Imagen por Resonancia Magnética , Piomiositis/diagnóstico , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus , Articulación Esternoclavicular/microbiologíaRESUMEN
Septic pyogenic arthritis of the acromioclavicular joint is a rare entity that occurs in immunosuppressed patients or those with discontinuity of defense barriers. There are only 15 cases described in the literature. The diagnosis is based on clinical features and the isolation of a microorganism in synovial fluid or blood cultures. The evidence of arthritis by imaging (MRI, ultrasound or scintigraphy) may be useful. Antibiotic treatment is the same as in septic arthritis in other locations. Staphylococcus aureus is the microorganism most frequently isolated. Our objective was to describe the clinical features, treatment and outcome of patients diagnosed with septic arthritis of the acromioclavicular joint at a Rheumatology Department. We developed a study with a retrospective design (1989-2012). The medical records of patients with septic arthritis were reviewed (101 patients). Those involving the acromioclavicular joint were selected (6 patients; 6%).
Asunto(s)
Articulación Acromioclavicular/microbiología , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Femenino , Infecciones por Haemophilus/diagnóstico , Infecciones por Haemophilus/tratamiento farmacológico , Haemophilus parainfluenzae/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus agalactiae/aislamiento & purificación , Resultado del TratamientoRESUMEN
The acromioclavicular joint is rarely the site of septic arthritis. We conducted a retrospective review at our rheumatology department, which identified five cases within the last 6 years. All five patients were males, and their mean age was 63 years. Risk factors were consistently identified and included intravenous substance abuse, prior joint disease, a recent history of intraarticular injections, and a remote history of surgery. Joint aspiration was performed in all five patients and provided the organism in two patients. Blood cultures recovered Staphylococcus aureus in three patients, a coagulase-negative Staphylococcus in one patient, and no organism in one patient. Ultrasonography and/or magnetic resonance imaging established the early diagnosis in four patients and ruled out concomitant involvement of the glenohumeral joint. Only about 20 cases of septic arthritis of the acromioclavicular joint have been reported to date. This rare infection must be diagnosed rapidly to prevent joint destruction. The treatment is that usually recommended for septic arthritis.
Asunto(s)
Articulación Acromioclavicular , Artritis Infecciosa/diagnóstico , Articulación Acromioclavicular/diagnóstico por imagen , Articulación Acromioclavicular/microbiología , Adulto , Anciano , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/epidemiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Dolor de Hombro/microbiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
In immunocompetent patients, septic arthritis of the acromioclavicular (AC) joint is a rare entity. It can be difficult to discern from glenohumeral septic arthritis and AC joint impingement syndrome. The usual symptoms are fever, erythema, swelling, palpable pain over the AC joint, and pain with shoulder motion. The most commonly reported causative organism is a Staphylococcus or Streptococcus species. Haemophilus parainfluenzae is a rare cause of septic arthritis in any joint. Although limited to case reports in the literature, most H parainfluenzae skeletal infections occur after surgical intervention. To our knowledge, this is the first case report of AC septic arthritis with H parainfluenzae.
Asunto(s)
Articulación Acromioclavicular/microbiología , Artritis Infecciosa/diagnóstico , Infecciones por Haemophilus/diagnóstico , Haemophilus parainfluenzae , Articulación Acromioclavicular/cirugía , Anciano , Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Artritis Infecciosa/cirugía , Desbridamiento , Femenino , Infecciones por Haemophilus/tratamiento farmacológico , Infecciones por Haemophilus/microbiología , Infecciones por Haemophilus/cirugía , Humanos , Ofloxacino/uso terapéutico , Irrigación Terapéutica , Resultado del TratamientoAsunto(s)
Articulación Acromioclavicular/microbiología , Artritis Infecciosa/microbiología , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus , Articulación Esternoclavicular/microbiología , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/terapia , Terapia Combinada , Drenaje , Humanos , Imagen por Resonancia Magnética Intervencional , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/terapia , Ultrasonografía IntervencionalAsunto(s)
Articulación Acromioclavicular/patología , Artritis Infecciosa/diagnóstico , Dolor de Hombro/diagnóstico , Articulación Acromioclavicular/diagnóstico por imagen , Articulación Acromioclavicular/microbiología , Anciano , Antibacterianos/uso terapéutico , Artritis Infecciosa/microbiología , Artritis Infecciosa/terapia , Artrografía , Terapia Combinada , Desbridamiento , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Paracentesis , Articulación del Hombro/patología , Dolor de Hombro/etiología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/patología , Irrigación Terapéutica , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe the sonographic findings of septic arthritis of the acromioclavicular joint. DESIGN AND PATIENTS: A retrospective study of five male patients was carried out. Four of the patients were referred because of signs and symptoms suggestive of glenohumeral joint septic arthritis, one for signs and symptoms suggestive of septic arthritis of the acromioclavicular joint. All the acromioclavicular joints were evaluated with ultrasound, aspirated and the aspirate cultured. RESULTS: All patients had normal ultrasound findings of their glenohumeral joints and distended acromioclavicular joints as determined by ultrasound. Ultrasound examination elicited focal tenderness over the acromioclavicular joint. Aspirates of each acromioclavicular joint grew pyogenic organisms. CONCLUSION: Infection in the acromioclavicular joint is uncommon, but is seen in increased frequency in immune-compromised patients and intravenous drug users. A normal glenohumeral joint on ultrasound in a patient suspected of having a septic shoulder should prompt careful review of the acromioclavicular joint. Aspiration of the acromioclavicular joint is easily performed under ultrasound guidance.
Asunto(s)
Articulación Acromioclavicular/diagnóstico por imagen , Artritis Infecciosa/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus/aislamiento & purificación , Infecciones Estreptocócicas/diagnóstico , Streptococcus pneumoniae/aislamiento & purificación , Articulación Acromioclavicular/microbiología , Adulto , Artritis Infecciosa/microbiología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Succión , UltrasonografíaRESUMEN
We describe a patient with acquired immunodeficiency syndrome who developed Staphylococcus aureus septic arthritis and osteomyelitis of the acromioclavicular joint. The case is unusual because of the rarity of reported bone and joint infections in patients with acquired immunodeficiency syndrome and because of the indolent nature of the infection.