Prosthetic Knee Septic Arthritis due to Pseudomonas stutzeri

Abstract

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.

Infective endocarditis caused by Pseudomonas stutzeri in a patient with Marfan syndrome: Case report and brief literature review

“… Clinical description of P. stutzeri infection No. of reported cases Year of publication Country Reference Bacteremia in a patient with acute leukemia 1 1995 Spain [16] Meningitis in a patient with HIV infection 1 1996 Spain [17] Pleural empyema in a cirrhotic patient 1 1996 Spain [18] Bacteremia related to a bullous skin eruption 1 1996 Australia [19] Community-acquired pneumonia with empyema 1 1997 Spain [20] Endophthalmitis after cataract surgery 1 1998 Czech Republic [21] Community-acquired vertebral osteomyelitis 1 1999 USA [22] Prosthetic joint infection of the knee in a patient with acute promyelocytic leukemia 1 2000 Israel [23] Panophthalmitis with orbital abscess 1 2001 USA [24] Endocarditis caused by P. stutzeri and Streptococcus salivarius …”

Prosthetic vascular graft infection and prosthetic joint infection caused by Pseudomonas stutzeri

“…There are 5 documented cases of P. stutzeri joint infections [3], [16], [17], [18], [19], 3 of which were in native joints and 2 in prosthetic joints. Most of the cases had identifiable risk factors for a joint infection, including a foreign body (1), immunological deficiency (1), and anatomical abnormality (1).…”

Hidatik kiste ikincil karaciğer apsesinde nadir bir etken: pseudomonas stutzeri

“…HIV/AIDS, hematolojik maligniteler ve siroz gibi immünsüpresif hastalığı bulunan kişilerde, P. stutzeri'nin, ciddi enfeksiyonlara neden olduğunu gösteren olgu raporları bulunmaktadır [16][17][18][19] . Olgumuzun eşlik eden mevcut hastalıklarının, bağışıklık sistemi üzerine bilinen baskılayıcı bir etkisi bulunmamaktadır.…”