Septic arthritis of the acromioclavicular joint due to Streptococcus agalactiae. Case report

Abstract

Septic arthritis of the acromioclavicular joint is a rare entity: only 30 cases have been reported in the literature since 1985. We present the case of a 53-year-old diabetic male, with septic arthritis of one acromioclavicular joint due to Streptococcus agalactiae. Current condition characterised by neck pain, limited movement of the right shoulder; hyperthermia, hyperaemia and increased volume in the acromioclavicular joint. Upon physical examination, increased volume was found from the proximal third of the deltoid to the middle third of the clavicle, pain on palpation, localised hyperthermia, limited range of motion. X-ray with enlargement of soft tissues, presence of subcutaneous gas and increased space in the acromioclavicular joint compared with the contralateral. Ceftriaxone and Clindamycin were administered at therapeutic doses and an acromioclavicular arthrotomy was performed, obtaining 10 ml of purulent material from the sub-deltoid and 2 ml from the joint. Five days later, Streptococcus agalactiae was reported. Clinical improvement was observed and it was decided to discharge the patient. Resumen: La artritis séptica acromioclavicular (ASAC) es una entidad poco frecuente, desde 1985 se han reportado 30 casos en la literatura. Se presenta el caso de un paciente masculino, diabético, de 53 años, con ASAC monoarticular por Streptococcus agalactie. Padecimiento actual caracterizado por dolor en cuello, limitación al movimiento de hombro derecho, hipertermia, hiperemia y aumento de volumen en articulación acromioclavicular. A la exploración física, con aumento de volumen en tercio proximal de deltoides hasta tercio medio de clavícula, dolor a la palpación, hipertermia localizada, arcos de movilidad limitados. Rx con aumento de partes blandas, presencia de gas subcutáneo y aumento de espacio articular acromioclavicular en comparación con la contralateral. Se administra Ceftriaxona y Clindamicina a dosis terapéuticas y se realiza artrotomia acromioclavicular derecha, se obtiene 10cc de material purulento subdeltoideo y 2cc articular. Se reporta al 5° día Streptococcus agalactie. Presenta mejoría clínica y se decide egreso. Keywords: Septic arthritis, Acromioclavicular joint, Streptococcus agalactiae, Palabras clave: Artritis séptica, Articulación acromioclavicular, Streptococcus agalactie