Losing a Hip due to Inflamed Colon! Transient Self-limiting Colitis May Have Catastrophic Consequences

Abstract

Introduction: Septic arthritis is a single organism infection. Typically, organisms seed the blood stream and infect susceptible joints. Rarely, more than one organism will affect one joint, and extremely rare colonic bacteria will be responsible for causing joint infections. I am presenting a case of a patient who lost her new hip because of a persistent infection from colonic bacteria. Case Description: This is a 61-year-old white female with hypercholesterolemia and bilateral hip osteoarthritis. She had a right total hip replacement in 2011. She presented with pain and limping, for which her old joint was found to be dislocated. She underwent a revision surgery, for which her hip was replaced and abnormal bone growth was removed. Her hospital stay was uneventful, and she was sent home after three days. She came back three weeks later with fever 102 F, sever night sweats, anorexia, and purulent discharge from her surgical site. She only reported two days of diarrhea two weeks earlier, with occasional bright red blood on top of her stool that was self-limited, and she never saught medical attention for it. The patient was taken to the operation room, she underwent debridement for her surgical site, and cultures from her wound grew Prevotella disiens and Enterococcus faecalis. Because of bacterial persistence and lack of healing, her artificial joint was removed and an antibiotic spacer was inserted. She underwent 16 debridement surgeries over the duration of two months. Multiple attempts failed to reveal the source of her infection, and a gastrointestinal malignancy was suspected. Diagnostic colonoscopy was done, which revealed scaring in the colon mucosa at the area of the splenic flexure. The entire remaining colon, including the distal terminal ileum, looked normal. Random colon biopsies did not reveal any active inflammation or architectural distortion. Mucosal atrophy and transmural fibrosis were seen in the affected scarred area. Discussion: Prosthetic joints are more prone to be infected than native joints. Bacterial seeding from blood stream is the most common cause of septic arthritis. A single type of organism is responsible for most of the joint infections. Literature reported remote infections secondary to colonic bacterial seeding, and is mostly related to colon malignancy. Review of literature failed to reveal a case of septic arthritis caused by two different organisms seeded from a transiently inflamed colonic mucosa. Physicians should pay a special attention to patients undergoing surgery to avoid a post surgical drop in blood pressure, which may end up in catastrophic consequences.