Septic arthritis is a medical emergency that rarely occurs without direct trauma to a joint, compromise or trauma to the synovium, or internal hematogenous seeding from bacteremia. Infection of a single joint space is a cause for concern, and infection of multiple joints is even more rare and concerning. Human immunodeficiency virus (HIV) renders patients particularly susceptible to encapsulated bacteria as it compromises opsonization, humoral immunity, as well as neutrophil function. Neutrophils play an important role in preventing and fighting off infections of the synovium, and it is well documented that compromised neutrophil function can result in this peculiar infection. HIV is popularly acknowledged for its suppression of the lymphoid division of the immune system, particularly CD4 T-cells suppression. However, HIV's effects on myeloid cells are largely overlooked in medical academia, specifically with respect to neutrophil dysfunction. We will explore a case where compromised neutrophil function results in rare infiltration of Haemophilus influenzae resulting in polyarticular septic arthritis.

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM). Cerebral edema (CE) can complicate DKA management. We report a patient with no significant medical history who presented with DKA and a new-onset DM; she received the standard management with regular insulin and IV fluids, the management resulted in a rapid drop in serum osmolality, the patient`s mental status deteriorated and became nonresponsive, brain imaging confirmed CE, a few days later the patient was declared brain dead by neurology. This case highlights the importance of gradual correction of hyperosmolar conditions including hyperglycemia and urges all healthcare providers to closely trend glucose levels in the management of DKA.

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