Detaillierte Beitrags-Information
| Beitragstitel | Pneumococcal pyogenic arthritis of the shoulder with cartilage destruction following two steroid injections: An extremely rare complication in a healthy adult |
|---|---|
| Beitragscode | P087 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
|
| Abstract |
Introduction. Pneumococcal pyogenic arthritis after steroid injection for adhesive capsulitis of the shoulder is an extremely rare complication. Typically pneumococcal arthritis affects older patients with underlying medical comorbidities or risk factors. In this report, we describe a case of pneumococcal arthritis of the shoulder with cartilage destruction following two steroid injections in an otherwise healthy adult. Case Presentation. A 36-year-old man presented in our hospital with left shoulder pain and reduced shoulder motion since six weeks without prior trauma. Clinical examination revealed reduced range of motion for abduction and external rotation without clinical signs of infection. Rotator cuff strength was not impaired. A fluoroscopy-guided glenohumeral steroid injection was performed after clinically diagnosing adhesive capsulitis. At five weeks follow-up the patient reported pain relief, however range of motion did not improve significantly despite physiotherapy. A second steroid injection was scheduled in the radiology department. An irregular subchondral trabecular structure was evident under fluoroscopy, however this remained unnoticed at the time. Twelve days after the second injection an extensive pyogenic arthritis developed. Open debridement was performed at admission and aspirate and biopsies were taken. Streptococcus pneumoniae could be isolated. Malignancy was histologically excluded. Bacteremia or concomitant pneumococcal infection were not detected except for an unspecific gingivitis. Despite immediate surgical debridement, antibiotic therapy according to current guidelines and a second look, cartilage destruction could not be averted. Infection was treated successfully but the patient depended on oxycodone/naloxone and remained unable to work. Eight months after pneumococcal arthritis a short stem anatomic total shoulder arthroplasty was performed. Conclusion. Pneumococcal pyogenic arthritis typically occurs via hematogenous seeding from an extraarticular source. Intraarticular steroid injections have a local immunosuppressive effect that can facilitate bacterial seeding if a known or unknown concomitant pneumococcal infection is present. High suspicion is crucial if fluoroscopy shows an irregular subchondral bone that may indicate subchondral bone infarction secondary to bacterial arthritis and further imaging and joint aspiration for culture may be necessary to establish a diagnosis. |