Rare case of postpartum septic arthritis of the shoulder caused by multi-drug resistant Kingella kingae: A case report

Abstract

Introduction: Septic arthritis is a severe joint infection that can cause permanent damage if not promptly treated. Although the shoulder is an uncommon site for this condition, Kingella kingae, typically associated with pediatric infections, can occasionally be a causative agent. Postpartum septic arthritis is rare, making this case particularly unique.

Presentation of case: We report a case of a 28-year-old woman who developed severe pain, swelling, and restricted movement in her left shoulder three weeks postpartum. Septic arthritis due to multi-drug resistant Kingella kingae was diagnosed via PCR analysis of the synovial fluid. The patient was successfully managed with intravenous antibiotics and arthroscopic drainage.

Discussion: This case represents a rare instance of postpartum septic arthritis of the shoulder caused by Kingella kingae. The unusual presentation highlights the importance of considering septic arthritis in postpartum women presenting with shoulder pain, even without typical risk factors. The multi-drug resistance observed in this strain underscores the necessity for comprehensive antibiotic susceptibility testing and individualized treatment strategies.

Conclusion: This case demonstrates that successful management of postpartum septic arthritis caused by Kingella kingae can be achieved through early diagnosis, targeted antibiotic therapy, and minimally invasive surgical intervention. It emphasizes the importance of a multidisciplinary approach, thorough diagnostic evaluation, and heightened clinical suspicion in postpartum women with shoulder pain to prevent long-term complications.

Keywords: Arthroscopy; Kingella kingae; Post-partum; Septic arthritis; Shoulder.

Fig. 1

Clinical appearance of the shoulder showing swelling, and erythema.

Fig. 2

Macroscopic appearance of the joint fluid following ultrasound-guided aspiration, showing cloudy, slightly sero-hematic fluid.

Fig. 3

X-ray of the left shoulder shows no abnormalities.

Fig. 4

Arthroscopic findings showing patchy hypertrophy of the synovium with fragile and false membranous layers.

Fig. 5

biopsy fragments at ×200 magnification indicating inflammatory synovium with neutrophil polynuclear cells and macrophages with presence of coccobacillus colonies.

Fig. 6

synovium biopsy at ×100 magnification clearly shows irregular inflammatory cells effusion with irregular synovium hypertrophy.