Pantoea agglomerans as a cause of septic arthritis after palm tree thorn injury; case report and literature review

Abstract

We report the case of a 14 year old healthy boy, who was admitted six weeks after being injured by a palm tree thorn, with limping caused by pain and swelling in his right knee. An ultrasound examination revealed a foreign body in the posterior lateral aspect of the right knee. Pantoea agglomerans was identified in the synovial fluid. The patient underwent two arthrotomies and was treated with amoxicillin-clavulanate intravenously for three weeks. The postoperative course was uneventful, and joint function returned to normal. A review of the literature between 1953 and 2002 revealed that bacterial growth after plant thorn injuries is reported infrequently. Yet when reported, Pantoea agglomearns is the most common organism found. Therefore, it must be considered and suspected in "aseptic" cases of arthritis, when there is a history of a plant thorn injury. We also emphasise the efficacy of ultrasound examination in these cases to identify the presence and location of a plant thorn.

Figure 1

A foreign body with approximate length of 8 mm (the date palm thorn) is seen in the posterior lateral aspect of the knee (between the black arrows).

Figure 2

The date palm (Phoenix dactylifera).

Figure 3

The thorn tip of the date palm (0.5–1.5 cm) (black arrows).