Shoulder septic arthritis following routine influenza vaccination

Abstract

The UK vaccination guidelines state that skin cleansing is not essential in socially clean patients. This report discusses a 69-year-old type 2 diabetic patient with a 4-week history of left shoulder pain with no precipitating factors other than a ‘flu vaccination without having had skin alcohol cleansing. She sustained a swollen left painful shoulder. Aspiration fluid grew Staphylococcus aureus and imaging confirmed diagnosis of septic arthritis. She underwent shoulder debridement and was started on antibiotics. Imaging 6 months later shows the sequelae of septic arthritis. The patient had ongoing stiffness and pain at 6 months. This report raises the question of whether there needs to be a revision of routine skin cleansing practice before vaccinations in certain groups of individuals.

Septic arthritis of shoulder joint following a COVID-19 vaccination: A case report

“…DeRogatis and team [13] reported a case of septic arthritis after a pneumococcal polysaccharide vaccine, following which shoulder pain developed in 24 h. The risk factor in this patient was old age (90 years). Damisa et al [14] reported a case of a 69-year-old woman who developed septic arthritis of the left shoulder joint 4 weeks after an influenza vaccination. She had type II diabetes mellitus and atrial fibrillation which were being treated with oral metformin and oral warfarin, respectively.…”

Septic Arthritis of the Shoulder After SARS-CoV-2 Pfizer Vaccination

“…Using this criteria, our female patient, weighing 59 kg, would have received the injection using a 5/8-inch needle rather than the 1-inch needle she was vaccinated with. A review of vaccine-related infections further suggests that alcohol swabs are a low-cost intervention that may prevent high-cost infectious sequela, such as osteomyelitis, sepsis, and abscess formation 5,24,25 .…”

“…Uncommon reactions have been reported in trial publications including 4 cases of Bell's palsy with the Moderna vaccine 2,4 . Local inflammatory reactions, including bursitis, and infectious processes, including septic arthritis, have been documented with previous vaccines [5][6][7] . Septic arthritis of the shoulder has been documented after pneumococcal and influenza vaccination often ascribed to the poor technique 6,8 .…”

“…Local inflammatory reactions, including bursitis, and infectious processes, including septic arthritis, have been documented with previous vaccines [5][6][7] . Septic arthritis of the shoulder has been documented after pneumococcal and influenza vaccination often ascribed to the poor technique 6,8 . Although the SARS-CoV-2 has been associated with cases of reactive arthritis, to the best of the authors' knowledge, no vaccine-associated septic arthritis has been reported 9,10 .…”

Myositis unrelated to the inoculation site after COVID-19 vaccination: a case report

“…inflammation and infectious reactions including bursitis and septic arthritis [1,4]. With intramuscular vaccination, the deltoid muscle is exposed to modified contaminants through direct inoculation, which can develop into myositis at the injection site.…”