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Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review
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Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review
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Journal Article
Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review
2021
Overview
Background
Enterobacter cloacae
(
E. cloacae
) is one of the commensal flora in the human intestinal tract and a prevalent nosocomial pathogen, which rarely causes infectious osteoarthritis in immunocompetent patients without recent trauma or surgery. Here, we report the first case of septic monoarthritis of the shoulder caused by
E. cloacae
in an immunocompetent patient.
Case presentation
A 52-year-old female with a 6-year history of right shoulder pain was referred to our emergency department due to fever, acute severe shoulder pain, and swelling. Blood test showed elevated inflammatory markers. The patient denied any recent invasive surgical procedure and trauma. She was misdiagnosed with a frozen shoulder, and the anti-inflammatory painkiller celecoxib for symptomatic treatment was ineffective. Magnetic resonance imaging (MRI) showed a shoulder joint abscess and supraspinatus tendon tear. The joint aspirate culture showed
E. cloacae
. After late diagnosis, she was treated with levofloxacin and underwent surgical debridement and irrigation. Her follow-up data revealed that she did not suffer from shoulder swelling and severe pain.
Conclusion
This is a rare case of
E. cloacae
infected arthritis of the shoulder in an immunocompetent patient with a rotator cuff tear, indicating that even if the symptoms and age of the patients match the characteristics of frozen shoulder, the possibility of septic arthritis should be considered in the presence of fever and increasing inflammatory markers. The cases of our literature review suggest that the patients subjected to invasive procedure may develop a subsequent
E. cloacae
osteoarticular infection, regardless of being asymptomatic after the procedure.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Anti-Bacterial Agents - therapeutic use
/ Arthritis, Infectious - diagnosis
/ Arthritis, Infectious - drug therapy
/ Arthritis, Infectious - microbiology
/ Arthritis, Infectious - surgery
/ Bacteria
/ Bacterial and fungal diseases
/ Complications and side effects
/ Enterobacter cloacae - isolation & purification
/ Enterobacteriaceae infections
/ Enterobacteriaceae Infections - diagnosis
/ Enterobacteriaceae Infections - drug therapy
/ Enterobacteriaceae Infections - microbiology
/ Enterobacteriaceae Infections - surgery
/ Female
/ Fever
/ Humans
/ Levofloxacin - therapeutic use
/ Markers
/ Medicine
/ Pain
/ Patients
/ Sepsis
/ Shoulder
/ Shoulder Pain - microbiology
/ Surgery
/ Swelling
/ Trauma
