Spontaneous Bacterial Arthritis in a Cirrhotic Patient

Abstract

Septic arthritis is usually of hematogenous origin and is increasingly being reported in elderly patients, who often have underlying medical conditions such as diabetes or alcoholism. We report a 62-year-old patient with alcoholic liver disease who presented with Escherichia coli bacteremia and septic arthritis in a previously fractured ankle. There are scarce reports of infectious arthritis in cirrhotic patients, but this is the first report of arthritis after a primary enteric bacteremia. We believe that the patient described here developed E. coli bacteremia as a result of bacterial overgrowth and translocation related to alcoholic liver disease and cirrhosis. The resulting bacteremia resulted in the development of infection in the left ankle, which had preexisting disease and was thus vulnerable. This case provides further evidence for the mode of infection being bacteremia in cirrhotic patients. In patients with cirrhosis and fever, a high index of suspicion is required for joint infection as a potential cause of fever or deterioration in the cirrhotic's patient general condition.

A hot, swollen joint in a cirrhotic patient

“…It is known that spontaneous bacterial arthritis is a rare complication of bacteraemia in cirrhotic patients,6 with the knee joint being most commonly affected. It has been postulated that the mode of infection in cirrhotic patients is haematogenous spread following bacteraemia 7…”

Klebsiella pneumoniae Septic Arthritis in a Cirrhotic Patient with Hepatocellular Carcinoma

“…Spontaneous bacterial arthritis is a rare complication of bacteremia in cirrhotic patients (4). The knee joint is the most commonly affected, while the shoulder, sternoclavicular joint, and ankle may also be involved.…”

“…The most commonly implicated bacteria are E. coli and Streptococcus agalactiae . There have been cases of Staphylococcus aureus and Plesiomonas shigelloides (4, 16-22). In our case, K. pneumoniae was isolated from the joint fluid, which is one of the most common isolates from ascites in patients with SBP.…”

“…Although spontaneous bacterial peritonitis is a frequent and serious complication in cirrhotic patients with ascites, spontaneous bacterial arthritis is a rare complication of bacteremia in cirrhotic patients (3, 4). We describe the first reported case of a 65-yr-old patient with liver cirrhosis and hepatocellular carcinoma who developed Klebsiella pneumoniae septic arthritis and peritonitis.…”

Cirrhosis-related musculoskeletal disease: radiological review

“…Metabolic derangements and impaired immunity make patients with liver cirrhosis more prone to infections, osteoporosis and osteonecrosis and hence to septic arthritis. [20][21][22][23] Large joints with abundant blood supply to the metaphyses are most prone to bacterial infection, with the most commonly affected joints being the hip, knee and shoulder. Patients usually present with pain and swelling over the affected joint with fever.…”