A 42-year-old patient presented acutely with bacteremic pneumococcal pneumonia along with metastatic pneumococcal infection of the hip joint. Diagnostic evaluation revealed evidence of a pre-existing bilateral hip osteonecrosis. The osteonecrotic changes were attributed to chronic alcohol abuse and/or an old motor vehicle accident. Appropriate therapy was promptly instituted and the septic arthritis responded well, necessitating hip aspiration only once. A few months later, the patient had no permanent sequelae of the infection.
* Streptococcus pneumoniae septic arthritis should be suspected in patients with arthritic symptoms and a concomitant pneumococcal infection.
* S pneumoniae septic arthritis of the hip is an uncommon infection, associated with certain predisposing factors. Osteonecrosis is an exceedingly rare predisposing factor.
* Prompt diagnosis and treatment are essential to prevent joint damage.
1. Goldenberg DL, Reed JI. Bacterial arthritis. N Engl J Med 1985;312:764–771.
2. Torres J, Rathbun HK, Greenough WB. Pneumococcal arthritis: report of a case and review of the literature. Johns Hopkins Med J 1973;132:234–241.
3. Ispahani P, Weston VC, Turner DP, et al. Septic arthritis due to Streptococcus pneumoniae in Nottingham, United Kingdom, 1985–1998. Clin Infect Dis 1999;29:1450–1454.
4. James PA, Thomas MG. Streptococcus pneumoniae septic arthritis in adults. Scand J Infect Dis 2000;32:491–494.
5. Kauffman CA, Watanakunakorn C, Phair JP. Pneumococcal arthritis. J Rheumatol 1976;3:409–419.
6. Turner DP, Weston VC, Ispahani P. Streptococcus pneumoniae spinal infection in Nottingham, United Kingdom: not a rare event. Clin Infect Dis 1999;28:873–881.
7. Ross JJ, Saltzman CL, Carling P, et al. Pneumococcal septic arthritis: review of 190 cases. Clin Infect Dis 2003;36:319–327.
8. Good AE, Gayes JM, Kauffman CA, et al. Multiple pneumococcal pyarthrosis complicating rheumatoid arthritis. South Med J 1978;71:502–504.
9. Merle-Melet M, Tortuyaux JM, Condette S, et al. Early postsplenectomy arthritis caused by penicillin-resistant Streptococcus pneumoniae. Eur J Clin Microbiol Infect Dis 1996;15:159–160.
10. Wollner A, Gilon D, Mattan Y, et al. Pneumococcal infection of a prosthetic hip joint. Int Orthop1989;13:135–136.
11. Sanzen L. Spread of Streptococcus pneumoniae between artificial joints in a rheumatoid patient.Acta Orthop Scand 1991;62:597–598.
12. Maniloff G, Greenwald R, Laskin R, et al. Delayed postbacteremic prosthetic joint infection. Clin Orthop 1987;223:194–197.
13. Raad J, Peacock J. Septic arthritis in the adult caused by Streptococcus pneumoniae: a report of 4 cases and review of the literature. Semin Arthritis Rheum 2004;34:559–569.
14. Ciernik IF, Gerster JC, Burckhardt P. Destructive pneumococcal septic arthritis in end-stage renal disease. Clin Rheumatol 1997;16:477–479.
15. Rivera P, Wilson M, Rubinfeld RS. Pneumococcal keratitis, bacteremia, and septic arthritis in an asplenic patient. Cornea 1996;15:434–436.
16. Mallory TH. Sepsis in total hip replacement following pneumococcal pneumonia. A case report. J Bone Joint Surg Am 1973;55:1753–1754.
17. Baghai M, Osmon DR, Wolk DM, et al. Fatal sepsis in a patient with rheumatoid arthritis treated with etanercept. Mayo Clin Proc 2001;76:653–656.
18. Assouline-Dayan Y, Chang C, Greenspan A, et al. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum 2002;32:94–124.
19. Jacobs NM. Pneumococcal osteomyelitis and arthritis in children. A hospital series and literature review. Am J Dis Child 1991;145:70–74.
20. Syrogiannopoulos GA, McCracken GH Jr, Nelson JD. Osteoarticular infections in children with sickle cell disease. Pediatrics 1986;78:1090–1096.