SHM Converge Scientific Abstract ePoster Gallery-'Dry' Septic Arthritis in Native Hips With Bacteremia Presented With Almost All Negative Work Up Ended Up With Multiple Organ Failure

'Dry' Septic Arthritis in Native Hips With Bacteremia Presented With Almost All Negative Work Up Ended Up With Multiple Organ Failure

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This case report describes a 69-year-old man with hypertension and osteoarthritis who presented after a fall with worsening hip and back pain. Initial evaluation was confusing: he was afebrile, had a normal white blood cell count, and imaging of the hips showed no joint effusion. A joint aspiration was also a “dry tap,” which often argues against septic arthritis. However, inflammatory markers were markedly abnormal, especially CRP, which was very high and later rose further.<br /><br />At first, the patient remained stable, but he later clinically deteriorated with lethargy, low urine output, rising WBC count, kidney injury, hyperbilirubinemia, and worsening inflammatory markers. Repeat CT and MRI again showed no clear effusion. Blood cultures and joint fluid cultures eventually grew Streptococcus dysgalactiae. He was started on broad-spectrum antibiotics, and surgery found only a very small amount of purulence within the joint capsule, confirming septic arthritis despite the negative imaging and dry aspiration.<br /><br />The hospital course was severe and complicated by multiorgan failure, including respiratory failure requiring intubation, hemodialysis, encephalopathy, psoas hematoma, and pulmonary embolism. After surgery and treatment, he was eventually extubated, and his mobility and mental status improved gradually over the following two weeks.<br /><br />The main message is that native-hip septic arthritis can rarely present as a “dry” joint with no effusion on exam, imaging, or aspiration. In such cases, normal ESR and CRP may help exclude infection, but elevated CRP and ESR should keep septic arthritis high on the differential even when early work-up appears negative.

Asset Subtitle

Xiaomei Meng

Meta Tag

Author List Xiaomei Meng

Category Clinical Vignettes

Concept Septic Arthritis

Concept C-reactive protein

Concept Erythrocyte Sedimentation Rate

Concept Native Hip

Concept Joint Aspiration

Distinguished Non-Finalist

Presenter Organization Ohio State University Medical Center

Presenting Author Xiaomei Meng

Track Adult

Keywords

septic arthritis

native hip

dry tap

joint aspiration

Streptococcus dysgalactiae

C-reactive protein

inflammatory markers

multiorgan failure

hip pain

blood cultures

Septic Arthritis

C-reactive protein

Erythrocyte Sedimentation Rate

Native Hip

Joint Aspiration