Pseudomonas stutzeri is a Gram-negative, nonfermenting rod. It is a saprophyte found in soil and water, and is rarely involved in human infections such as bacteremia, community-acquired pneumonia, osteomyelitis, endocarditis, meningitis, otitis media, septic arthritis or wound and eye infections (1-4). This organism has been isolated from the hospital environment (5-7). We report a case of septic arthritis of a prosthetic knee in a 73-year-old woman. To our knowledge, this is only the third reported case of septic arthritis and the first of a prosthetic joint infection due to this organism (3,4).
CASE REPORTA 73-year-old woman with a recent history of acute promyelocytic leukemia, which had been treated orally with all-trans retinoic acid 15mg/m 2 , was admitted to the Department of Internal Medicine at Rabin Medical Center due to fever and pancytopenia. Medical history revealed cholecystectomy for cholelithiasis and pancreatitis, and a total right knee replacement for severe osteoarthrosis several years previous.On admission, the patient was moderately ill, with pallor and widespread ecchymoses covering her entire body. Temperature was 38.6°C; blood pressure was 170/85 mmHg; pulse 110 beats/min and respiration rate 28 breaths/min. The rest of the physical examination was normal. Laboratory tests revealed the following values: hemoglobin 92 g/L, hematocrit 26%, white blood cell count 1200×10 9 /L (40% neutrophils); platelet count 34×10 9 /L, prothrombin time (international normalized ratio) 1.20; serum glucose 9.8 mmol/L; and lactate dehydrogenase level 12.8 µkat/L. Serum creatinine, blood urea-nitrogen, electrolytes, calcium, phosphorous and liver enzyme levels, and urinalysis tests were within normal limits. A chest x-ray appeared normal. Prosthetic joint infection is usually caused by Staphylococcus aureus, coagulase-negative staphylococci and, less commonly, by Gram-negative bacilli and anaerobes. A case of prosthetic joint infection due to Pseudomonas stutzeri in a 73-year-old female with acute promyelocytic leukemia is presented, and the pertinent literature is reviewed. Although the patient had prolonged neutropenia, the infection was successfully treated with antibiotics and without artificial joint replacement.