Bilateral Acromioclavicular Septic Arthritis as an Initial Presentation of Streptococcus pneumoniae Endocarditis

Table 1

Clinical and bacteriological features in previously reported cases of septic arthritis of the acromioclavicular joint.

Study	Sex	Age	Comorbidity/risk factors	Echocardiography result	Organism	Treatment
Good et al., 1978 [7] (bilateral)	M	41	None	TTE positive	GBS	Penicillin G + gentamicin
Adams and McDonald, 1984 [11]	—	57	Chronic steroid use, sarcoidosis	—	Cryptococcus  neoformans	Surgical resection
Blankstein et al., 1985 [12]	M	48	Recent trauma	—	S. viridans	Antibiotic + surgical drain
Zimmermann et al., 1989 [13]	M	27	HIV	—	S. aureus	Surgical washout and resection of the distal clavicle + ciprofloxacin
Hughes et al., 1992 [14]	M	39	AIDS	—	Salmonella	Ciprofloxacin
Neault et al., 1996 [15]	M	26	Repair of a left type III AC joint separation with Dacron tape 5 years earlier	—	—	Surgical debridement and vancomycin
Widman et al., 2001 [4] (5 cases)	M	44	IV drug use, DM, hemodialysis	—	S. aureus	—
	M	41	Lymphoma treated but not on chemotherapy now	—	S. pneumoniae	—
	—	51	IV drug	—	S. aureus	—
	—	44	IV drug	—	S. aureus	—
	—	40	IV drug	—	S. aureus	—
Hammel and Kwon, 2005 [8]	M	68	DM	TEE negative	GBS	IV penicillin G
Laktasic-Zerjavic et al., 2005 [16]	M	44	DM	—	S. aureus	Antibiotic
Zicat et al., 2006 [17]	M	62	Knee replacement complicated by infection with the same pathogen	—	S. aureus	—
Chiang et al., 2007 [5]	F	55	MM, chemotherapy	—	S. pneumonia	Ceftriaxone + open AC joint resection and then linezolid
	F^a	56	MM, chemotherapy	—	S. viridans	I & D and excision of distal clavicle + ceftriaxone
	F	79	—	—	GBS	Joint aspiration + ceftriaxone
	M	65	DM and renal insufficiency	—	—	Aspiration + pip/taz + nafcillin
Murdoch and McDonald, 2007 [18] (bilateral)	M	57	RA on prednisone and AZA, joint injection	—	MAI	I & D, azithromycin, moxifloxacin, ethambutol, and rifabutin
Tan et al., 2007 [19]	F	53	None, living in Singapore for 14 years	—	MTB	Rifampicin, isoniazid, ethambutol, and pyrazinamide
Battaglia, 2008 [20]	M	17	Trauma to shoulder followed by joint injection	—	Ochrobactrumanthropi	Irrigation and excision of distal clavicle + ciprofloxacin
Cone et al., 2008 [21]	M	63	DM	—	S. aureus	Surgical drainage + oxacillin
Iyengar et al., 2009 [22]	M	42	None	—	S. aureus	Flucloxacillin and oral fusidic acid
Bossert et al., 2010 [6] (5 cases)	M	74	DJD with preexisting cyst of AC joint	TEE positive	S. aureus	Oxacillin + gentamicin
	M	55	h/o dysmetabolic syndrome and gout	—	S. aureus	Oxacillin + ciprofloxacin
	M	64	COPD, RA not on DMARD	TTE negative	—	Oxacillin + ciprofloxacin
	M	38	IV drug use, hepatitis B and C, surgery several years earlier for fracture-dislocation	—	S. aureus	I & D, rifampin + ofloxacin
	M	62	AC joint steroid injection for pain	—	S. aureus	Ofloxacin and cloxacillin
Noh et al., 2010 [23]	M	63	DM	—	S. aureus	I & D and distal clavicle resection
Carey et al., 2010 [24]	M	65	None	—	H.  parainfluenzae	I & D and levofloxacin

aSame patient listed above after 1 year.
AC: acromioclavicular; AZA: azathioprine; COPD: chronic obstructive pulmonary disease; DJD: degenerative joint disease; DM: diabetes mellitus; DMARD: disease-modifying antirheumatic drugs; GBS: group B Streptococcus; HIV: human immunodeficiency virus; I & D: incision and drainage; IV: intravenous; MAI: mycobacterium avium-intracellular; MM: multiple myeloma; MTB: mycobacterium tuberculosis; pip/taz: piperacillin/tazobactam; RA: rheumatoid arthritis; TEE: transesophageal echocardiography; TTE: transthoracic echocardiography; VAD: vincristine, doxorubicin, and dexamethasone.