SHM Converge Scientific Abstract ePoster Gallery-Holy Shot! Bilateral Knee Septic Arthritis and Meningitis After Injection

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This case describes a 66-year-old man with significant comorbidities, including diabetes, chronic kidney disease, coronary artery disease, and bilateral knee osteoarthritis, who presented to the ED with abrupt, severe worsening bilateral knee pain. Although he initially denied fever or recent procedures, he developed respiratory distress, lethargy, tremors, and loss of consciousness, requiring intubation and ICU admission.<br /><br />Exam showed bilateral knee swelling and marked tenderness without obvious erythema or warmth. Workup revealed elevated inflammatory markers and signs of infection, and orthopedic aspiration of both knees produced cloudy, purulent fluid consistent with septic arthritis. Empiric cefepime and vancomycin were started. Because the patient remained encephalopathic and difficult to extubate, additional evaluation was pursued, including MRI brain, EEG, and lumbar puncture. MRI showed no acute abnormalities, EEG demonstrated nonspecific encephalopathy, and CSF analysis was highly consistent with bacterial meningitis, with 10,000 WBCs, 97% neutrophils, very low glucose, and markedly elevated protein. Blood, joint aspirate, and CSF cultures all grew Streptococcus pneumoniae. Antibiotics were narrowed to high-dose IV penicillin G, after which his mentation gradually improved and he was extubated.<br /><br />Later history revealed that he had received multiple steroid injections to both knees at an outside hospital, making iatrogenic septic arthritis the most likely source. The untreated joint infection likely seeded the bloodstream and led to pneumococcal meningitis. The report emphasizes that septic arthritis is an orthopedic emergency, that post-injection septic arthritis is uncommon but more likely in patients with repeated injections and comorbid illness, and that persistent altered mental status after treating septic arthritis should prompt broader evaluation for additional infectious or neurologic causes.

Asset Subtitle

Hiba N. Mohiuddin

Meta Tag

Author List Hiba N. Mohiuddin

Category Clinical Vignettes

Concept Septic Arthritis

Concept Orthopedic Emergency

Concept Joint Injection

Concept Bacteremia

Concept Meningitis

Distinguished Non-Finalist

Presenter Organization Rush Copley Medical Center

Presenting Author Hiba N. Mohiuddin

Track Adult

Keywords

septic arthritis

Streptococcus pneumoniae

bacterial meningitis

bilateral knee pain

steroid injections

iatrogenic infection

diabetes

chronic kidney disease

encephalopathy

orthopedic emergency

Septic Arthritis

Orthopedic Emergency

Joint Injection

Bacteremia

Meningitis