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Case Reports
. 2020 Mar 6;12(3):e7196.
doi: 10.7759/cureus.7196.

Driveline Sepsis Presenting As Gout

Brittney Toms  1
Affiliations
Case Reports

Driveline Sepsis Presenting As Gout

Brittney Toms. Cureus. .

Abstract

In patients with a history of gout, there could be a delay in diagnosis of a septic joint, which increases morbidity and mortality. The literature reports rare instances of coexistent gout and septic arthritis. We present a 64-year-old male with non-ischemic cardiomyopathy, supported by a HeartWare ventricular assist device, who developed a methicillin-resistant Staphylococcus aureus (MRSA) driveline infection four months after device implant. He achieved suppression with minocycline 100 mg by mouth twice a day for five months before presenting to the emergency room with symptoms of gout. Joint aspirate was consistent with a diagnosis of MRSA as well as gout. The patient presented with typical symptoms of a percutaneous driveline infection: soreness at the exit site, erythema, and thick, purulent drainage. Wound culture of the driveline confirmed MRSA and guided antibiotic treatment. His presentation was unusual in that sepsis was identified only after he presented with septic arthritis, which led to the collection of blood cultures. He had no fever, chills, nausea, vomiting, or hypotension. This case illustrates that unresolving gout symptoms after one treatment, in a patient with a known driveline infection, should be further evaluated for possible sepsis and septic arthritis. The patient's unusual presentation of sepsis caused difficulties in diagnosis and management. To our knowledge, this is the first reported case of a driveline infection seeding a joint and causing septic arthritis.

Keywords: arthritis; gout; heart failure; left ventricular assist device (lvad); mechanical circulatory support (mcs); sepsis; septic arthritis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT of the Thorax
No fluid collection noted around the pump.
Figure 2
Figure 2. CT Scan of the Abdomen and Pelvis
No fluid collection noted along the driveline.
Figure 3
Figure 3. Left Knee
The figure depicts a left knee x-ray demonstrating osteoarthritis and a substantial joint effusion.
Figure 4
Figure 4. Positron Emission Tomography (PET) Scan
The figure depicts a full body PET scan demonstrating hypermetabolic activity distal to the pump (red arrow) and increased metabolic activity in the left knee (purple arrow).
See this image and copyright information in PMC

References

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