Septic arthritis caused by serratia marcescens

Abstract

LETTERS 567 true that some newspapers or broadcasters may truncate or warp one of our stories by using parts of it out of context, we do our best to identify such offenders and try to set the record straight, though we are not always successful.As far as the auranofin story is concerned, we were misinformed by a drug company representative, whom we later learned was in no position to know the true facts about the likelihood of this drug being released in the near future. Our attempts to confirm his statement by contacting the senior investigator making the report at the ARA meeting were unsuccessful, and we were again misled by someone else on this point. We were eventually able to obtain the true facts in time to correct the story given out to the wire services but too late to reach newspapers, magazines, and other media which had been sent the advance story by mail. We apologize for this mistake and will try to be even more diligent in avoiding such errors in the future.Criticism such as that from Dr. Hanauer does us good by making us acutely aware of the heavy responsibility we have to patients, professionals, and the public to provide objective stories on controversial, everchanging subjects. FREDERIC C. MCDUFFIE, MD Senior Vice President for CHARLES C. BENNETT Medical Affairs Vice President for Public Arthritis Foundation Atlanta, Georgia and Professional Education Septic arthritis caused by Serrutiu murcescens To the Editor:Since its discovery, Serratia marcescens has been considered a saprophyte and a relatively avirulent microorganism; however, its pathogenicity has become increasingly apparent in the last several decades. S marcescens infection can be found at many sites, with localization at the joint level one of the rarer forms.We have found 24 cases in the literature of septic arthritis produced by S marcescens (1-12). All of these studies reported on patients with chronic systemic diseases, drug addiction, or intravenous, arterial, or urinary catheters or endotracheal tubes; or on prolonged patient treatment with antibiotics, steroids, and immunosuppressive agents. In a patient we studied, however, none of these conditions were present.A 17-year-old man presented with pain of 3 years duration upon flexion of the left knee. His history revealed no trauma or other outstanding features. Two weeks before the current hospitalization, the patient was treated with 4 steroid injections (betamethasone 3 mg each) into the left knee. Seven days later, he presented with swelling, redness, local heat, pain, temperature increase to 38°C effusion upon tension of the left ankle with functional impairment that had increased until the time of his hospitalization, and slight pain upon passive mobilization of the left knee. Results of the remainder of the physical examination were normal.The blood count demonstrated 9,500 white blood cells (WBC) with a small left shift and an erythrocyte sedimentation rate of 50-80 mm/hour. Alkaline phosphatase was 110 pm/ml (normal 80 pm/ml); urine analysis, SGOT, SGPT, total bilirub...