Case Report: Streptococcus Gallolyticus Prosthetic Joint Infection

Authors

Jeffrey Dickerson, HCA HealthcareFollow
Liza Salloum
Amaan Sheikh
Madhukanth Reddy
Bryan Youree

Files

Division

North Texas

Hospital

Medical City Weatherford

Specialty

Internal Medicine

Document Type

Presentation

Publication Date

2024

Keywords

Streptococcus gallolyticus

Disciplines

Bacterial Infections and Mycoses | Internal Medicine | Medicine and Health Sciences

Abstract

Streptococcus gallolyticus, part of the Streptococcus bovis/Streptococcus equinus complex (SBSEC) formerly known as Group D streptococi, is strongly associated with colorectal cancer and infective endocarditis. Its appearance in septic arthritis is rare, and its role in septic arthritis has not been as thoroughly investigated. We present the case of a 69 year old male with a history of atrial fibrillation and hypertension who was admitted to our hospital after undergoing a right knee replacement in 2023 with a chief complaint of right knee pain, fever, and chills. Arthrocentesis and blood cultures were performed, and the patient was started on broad spectrum antibiotic therapy with vancomycin and cefepime for empiric therapy of septic arthritis. Patient’s arthrocentesis and blood cultures performed on admission grew Streptococcus gallolyticus sensitive to penicillin and ceftriaxone. On hospital day 3, patient’s antibiotic therapy was deescalated to ceftriaxone monotherapy due to a reported allergy to penicillin. Despite the association of this pathogen with infectious endocarditis, transesophageal echocardiogram performed on hospital day 3 and transthoracic echocardiogram performed on hospital day 5 were both negative for findings of valvular vegetation. Orthopedic surgery team was consulted, and the patient was recommended to transfer to a facility capable of alpha-defensin testing for assistance in diagnosing possible total joint infection. The patient was transferred to an outside facility capable of alpha-defensin testing, and he underwent multiple surgical interventions of the affected joint with full resolution of his infection. Transfer of records from this facility are still pending, but per conversation with the patient, he reports he is doing well since being discharged from this facility. Patient underwent colonoscopy at our facility which was negative for colorectal cancer, but significant for a villous polyp for which the patient will follow up for repeat colonoscopy in 3 years for surveillance. Although a rare finding in the case of septic arthritis, an infection with culture-confirmed Streptococcus gallolyticus is a one that nevertheless warrants swift and thorough workup due to its well-known comorbidity with colorectal cancer and infective endocarditis.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Dickerson, Jeffrey; Salloum, Liza; Sheikh, Amaan; Reddy, Madhukanth; and Youree, Bryan, "Case Report: Streptococcus Gallolyticus Prosthetic Joint Infection" (2024). North Texas GME Research Forum 2024. 6.
https://scholarlycommons.hcahealthcare.com/northtexas2024/6