Multifocal Septic Arthritis, Gluteal Abscess and Spondylodiscitis by Streptococcus Dysgalactiae Subspecies Equisimilis After an Intramuscular Injection

• Author(s): Pocinho, R ; Antunes, L ; Pires, P ; Baptista, I
• Date: 2017
• Persistent ID: http://hdl.handle.net/10400.17/3516
• Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
• Subject(s): Abscess; Arthritis, Infectious; Buttocks; Discitis; Humans; Injections, Intramuscular; Male; Middle Aged; Muscle, Skeletal; Streptococcal Infections; Streptococcus; HSJ MED
• Document Type: Journal article
• Language: English
• Contributor(s): Repositório da Unidade Local de Saúde São José

Description

We present the case of a 63-year-old man, admitted for hand cellulitis and acute kidney injury. A Streptococcus dysgalactiae subsp equisimilis (SDSE) was isolated in blood cultures and despite directed intravenous antibiotherapy, the patient evolved unfavourably, with dorsolumbar spondylodiscitis, multifocal septic arthritis and abscesses. CT also showed densification of the gluteal muscles, multiple air bubbles in the psoas, paraspinal muscles and spinal canal that were associated with an intramuscular injection administered 1 week earlier for a backache. After escalation of the antibiotherapy and intensive supportive measures, the patient showed improvement and was discharged after 8 weeks of antibiotherapy.The incidence of invasive SDSE infections has been growing, especially in immunosupressed patients. In this case, despite no predisposing factor identified, it evolved to severe sepsis. The intramuscular injection, a trivialised but not harmless procedure, was the assumed port of entry, as previously described in another case report.