Polyarticular Septic Arthritis Secondary to Septic Thrombophlebitis of the Brachiocephalic Vein: A Rare Case Report



      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.


      PASA (Polyarticular Septic Arthritis), IV (Intravenous), IVDU (Intravenous drug use), CT (Computed Tomography), AKI (Acute kidney injury), MSSA (Methicillin-sensitive Staphylococcus aureus)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Christodoulou C
        • Gordon P
        • Coakley G.
        Polyarticular septic arthritis.
        BMJ. 2006; 333: 1107-1108
        • Mathews CJ
        • Weston VC
        • Jones A
        • et al.
        Bacterial septic arthritis in adults.
        Lancet. 2010; 375: 846-855
        • Dubost JJ
        • Fis I
        • Denis P
        • et al.
        Polyarticular septic arthritis.
        Medicine. 1993; 72: 296-310
        • Lieber SB
        • Fowler ML
        • Zhu C
        • Moore A
        • Shmerling RH
        • Paz Z.
        Clinical characteristics and outcomes in polyarticular septic arthritis.
        Joint Bone Spine. 2018; 85: 469-473
        • Clements J
        • Dinneen A
        • Heilpern G.
        Polyarticular septic arthritis in an immunocompetent patient.
        Ann R Coll Surg Engl. 2013; 95: e34-e35
        • Lipe DN
        • Foris LA
        • King KC.
        Septic Thrombophlebitis.
        StatPearls, 2022
        • Miller A
        • Abduljabbar F
        • Jarzem P.
        Polyarticular septic arthritis in an immunocompetent adult: a case report and review of the literature.
        Case Rep Orthop. 2015; 2015602137
        • Volkow P
        • Cornejo-Juárez P
        • Arizpe-Bravo AB
        • et al.
        Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials.
        Thrombosis J. 2005; 3: 11
        • Verghese A
        • Widrich WC
        • Arbeit RD.
        Central venous septic thrombophlebitis—the role of medical therapy.
        Medicine (Baltimore). 1985; 64: 394-400
        • Wilson Dib R
        • Chaftari AM
        • Hachem RY
        • Yuan Y
        • Dandachi D
        • Raad II
        Catheter-related Staphylococcus aureus bacteremia and septic thrombosis: the role of anticoagulation therapy and duration of intravenous antibiotic therapy.
        Open Forum Infect Dis. 2018; 5: ofy249
        • Andes DR
        • Urban AW
        • Acher CW
        • Maki DG.
        Septic thrombosis of the basilic, axillary, and subclavian veins caused by a peripherally inserted central venous catheter.
        Am J Med. 1998; 105: 446-450