Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review

Abstract

Background Enterobacter cloacae (E. cloacae) is one of the commensal flora in the human intestinal tract and a prevalent nosocomial pathogen, which rarely causes infectious osteoarthritis in immunocompetent patients without recent trauma or surgery. Here, we report the first case of septic monoarthritis of the shoulder caused by E. cloacae in an immunocompetent patient. Case presentation A 52-year-old female with a 6-year history of right shoulder pain was referred to our emergency department due to fever, acute severe shoulder pain, and swelling. Blood test showed elevated inflammatory markers. The patient denied any recent invasive surgical procedure and trauma. She was misdiagnosed with a frozen shoulder, and the anti-inflammatory painkiller celecoxib for symptomatic treatment was ineffective. Magnetic resonance imaging (MRI) showed a shoulder joint abscess and supraspinatus tendon tear. The joint aspirate culture showed E. cloacae. After late diagnosis, she was treated with levofloxacin and underwent surgical debridement and irrigation. Her follow-up data revealed that she did not suffer from shoulder swelling and severe pain. Conclusion This is a rare case of E. cloacae infected arthritis of the shoulder in an immunocompetent patient with a rotator cuff tear, indicating that even if the symptoms and age of the patients match the characteristics of frozen shoulder, the possibility of septic arthritis should be considered in the presence of fever and increasing inflammatory markers. The cases of our literature review suggest that the patients subjected to invasive procedure may develop a subsequent E. cloacae osteoarticular infection, regardless of being asymptomatic after the procedure.

Whole-Genome Sequencing of Gram-Negative Bacteria Isolated From Bovine Mastitis and Raw Milk: The First Emergence of Colistin mcr-10 and Fosfomycin fosA5 Resistance Genes in Klebsiella pneumoniae in Middle East

“…Similarly, although we identified all E. cloacae as MDR isolates, they were previously reported with a low frequency (7.1%) in milk samples from Egypt in 2011 ( Ahmed and Shimamoto, 2011 ). However, they were recently detected in human samples ( Huang et al, 2021 ), which in turn emphasizes again the concept of transferring between animal/animal products including milk from/to human and animal during these 10 years. Alternatively, MDR K. pneumoniae isolates were widely detected in milk samples ( Yang et al, 2020 ) and this is concordant with what was reported in our study.…”

Molecular Characterization of KPC-2-Producing Enterobacter cloacae Complex Isolates from Cali, Colombia

“…This was the case of a 52-year-old female with infected arthritis of the right shoulder, whose joint aspirate culture showed a cefazolin-resistant E. cloacae. She was treated with levofloxacin, and she stopped experiencing shoulder swelling and severe pain [31]. Precisely, because sometimes there are few therapeutic options available to treat infections, in vitro studies using essential oils from plants have shown to have activity against multidrug-resistant Enterobacteriaceae isolates [32,33], which would be a basis for the development of new and effective antibacterial treatments.…”

Paediatric traumatic cataracts in Southwest China: epidemiological profile

“…In the present study, a more virulent species, E. cloacae [ 29 ], was involved in several cases. The isolated organism was reported to be a commensal organism of the gastrointestinal tract, rather than the ocular surface [ 30 ], and it can also be found in soil and plants. It therefore was no surprise that the cases in which E. cloacae was identified were caused by wooden sticks.…”