Abstract
Background
Polyarticular septic arthritis (PASA) accounts for approximately 15% of all septic
arthritides and is rare in immunocompetent adults. Even with appropriate therapy PASA's
mortality rate is nearly 50%.
Case Report
We report a rare presentation of PASA caused by idiopathic septic thrombophlebitis
of the brachiocephalic vein in an immunocompetent adult female patient who presented
with symptoms of right clavicular, left wrist, and right hip pain associated with
fevers. Methicillin-sensitive Staphylococcus aureus was isolated in blood cultures and joint aspiration of one of the affected hips.
Transesophageal echocardiogram was negative for valvular vegetations and computed
tomography chest with contrast revealed thrombi in the brachiocephalic and subclavian
veins extending to the superior vena cava. It also showed bilateral pulmonary nodules
consistent with septic pulmonary emboli. No clear precipitant for the underlying septic
thrombophlebitis was identified. Management was conservative, with systemic anticoagulation
and IV antibiotics. The patient's symptoms improved, and she was discharged to subacute
rehabilitation.
Why Should an Emergency Physician Be Aware of This?
Early diagnosis and treatment of PASA in the emergency department is imperative to
reducing overall morbidity and mortality associated with this condition. To the best
of our knowledge, this is the only case report of idiopathic septic thrombophlebitis
of the subclavian vein causing PASA in an immunocompetent adult.
Abbreviations:
PASA (Polyarticular Septic Arthritis), IV (Intravenous), IVDU (Intravenous drug use), CT (Computed Tomography), AKI (Acute kidney injury), MSSA (Methicillin-sensitive Staphylococcus aureus)Keywords
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Article info
Publication history
Published online: June 08, 2022
Accepted:
June 4,
2022
Received in revised form:
May 25,
2022
Received:
March 31,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
