Involvement of Campylobacter jejuni in septic arthritis: a case report

Manuela Colosimo,Laura Daprai,Anna Grancini,Erminio Torresani,Luca Gallelli,Antonella Restelli,Cristina Castelli,Aldo Giovanni Cimminiello

doi:10.1099/jmmcr.0.000095

Abstract

Introduction: Campylobacter jejuni is the most common cause of human bacterial enteritis in developed countries and is a rare cause of extra-intestinal infections. Case presentation: In this paper, we report a case of septic arthritis related to C. jejuni infection in an immunocompetent 53-year-old man with prosthetic devices who presented to us with enteritis. Following treatment with ciprofloxacin, loperamide hydrochloride and acetaminophen, he developed articular pain with painful swelling and redness in the region of the outer side of the left thigh. A diagnosis of a monoarticular non-migratory manifestation was postulated and vancomycin was started but was stopped 1 day later due to the development of skin erythema, and levofloxacin, teicoplanin and rifampicin treatment was started. An X-ray of the hip excluded dislocation of the prosthesis, while ultrasound showed an abscess in the soft tissue, confirmed by a triphasic bone scan. Aspiration of the joint fluid revealed the presence of moving, curved, Gram-negative bacilli 72 h after incubation, while growth on agar plates and tryptose broth remained negative after 5 days. Reactions for Campylobacter diagnosis were positive, and the micro-organism was identified as C. jejuni. Antimicrobial susceptibility tests revealed a sensitivity for ampicillin, ciprofloxacin, imipenem, tetracycline, erythromycin and gentamicin. Antimicrobial treatment was continued for a further 10 days with complete resolution of symptoms. Conclusion: Clinicians should consider Campylobacter in infections without a history of a travel in the tropics. Antibiotic treatment must be carefully evaluated to take into account the local resistance to avoid clinical failure.

Highlights

Campylobacter jejuni is the most common cause of human bacterial enteritis in developed countries and is a rare cause of extra-intestinal infections.Case presentation: In this paper, we report a case of septic arthritis related to C. jejuni infection in an immunocompetent 53-year-old man with prosthetic devices who presented to us with enteritis
Tissues resulting in cellulitis, septic arthritis, fasciitis, thrombophlebitis, myositis, erysipelas and ecthyma gangrenosum, and, when associated with disseminated intravascular coagulation, purpura fulminans (Cone et al, 2003) and reactive arthritis (ReA)
We report a case of septic arthritis related to C. jejuni infection in an immunocompetent patient

Summary

Introduction

Campylobacter jejuni is the most common cause of human bacterial enteritis in developed countries. The majority of cases of C. jejuni infections are self-limiting and do not require antibiotic treatment (Garg et al, 2008) More rarely they cause extra-intestinal infections as a result of haematogenous diffusion (Yao et al, 1993). A 53-year-old man was admitted to the Emergency Department of our hospital in Milan with fever (39.8 uC), chills, watery diarrhoea and a malaise of the joints His history revealed that a few days before the development of symptoms, he had returned from a trip in Sardinia, but he denied the consumption of raw or undercooked foods. The patient was readmitted for the persistence of symptoms and the development of articular pain (VAS: 6), and a new laboratory blood test revealed an increase in both CRP (37.27 mg dl21) and WBC count (14.75|109 l21).

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