This case is the first description to our knowledge of septicaemia with septic arthritis involving the shoulder and knee and with cervical spondylodiscitis due to S pneumoniae
. Whereas upper and lower respiratory tract, ear and sinus infections and meningitis are the most common manifestations of S pneumoniae
infection, bones and joints are less frequently targeted,6
and among those, 30% involve multiple locations.1 2 S pneumoniae
is found in 3% to 10% of the cases of septic arthritis reported in the literature.1 2 4 7
However, vertebral involvement has rarely been described,8 9
likely because symptoms lack specificity and are vague or almost absent,10
as observed in our case. Consequently, the usual delay in diagnosis has been reported to be 2–4 months.5
In our case, bone scintigraphy was effective in the early diagnosis of cervical spondylodiscitis; the bacteriological diagnosis was established with isolation of S pneumoniae
in both blood cultures, which usually rarely happens in cases of isolated vertebral spondylodiscitis,9
and fluid from the knee. Because haematogenous spread is considered to be the most important route for bone and joint pneumoccocal infection, patients should be evaluated for a primary site of infection. However, extra-articular foci are found in 40% to 60% of patients.1–3
In our case, S pneumoniae
probably originated from the gingiva because it is commonly colonised in children and adults,5
no evidence of infection was found elsewhere, and positron emission tomography CT features evoked gingivitis.
Thus, S pneumoniae should be considered routinely when faced with bone and joint infections, and multiple locations should be carefully sought owing to the possible lack of symptoms.
- Streptococcus pneumoniae should be considered routinely when faced with bone and joint infections.
- In cases of bone and joint pneumoccocal infection, patients should be evaluated for a primary site of infection.
- Multiple bone locations should be carefully sought owing to the possible lack of symptoms.