Septicemic Arthritis with Antibiotic Resistance: A Case Study

CASE PRESENTATION A 59-year-old male presented to the hospital with complaint of increasing joint and overall body pain with no other outstanding signs and symptoms. He had a history of rheumatoid arthritis, type II diabetes, viral hepatitis, recent slow healing sternal wound infection from coronary artery bypass surgery, right diabetic foot ulcer with osteomyelitis caused by Pseudomonas aeruginosa, and a left foot amputation. He took 20 mg of prednisone daily for his arthritis. At the time of initial examination, he had no clear effusion, swelling of any joints or erythema. The patient described his symptoms to be consistent with his arthritis. He later developed large effusions in his knees that were warm to the touch with slightly warm, swollen ankles. Physicians thought that rheumatoid arthritis was the major physiological disorder in this case and ruled out septic arthritis, leading them to increase the patient's dose of prednisone to 40 mg/day. Despite efforts to control the suspected arthritis, the patient's joint pain worsened with swelling in his elbows. The patient also developed tachycardia, suspected to be from the pain. Physicians ordered blood and synovial fluid cultures while maintaining steroid therapy. The synovial fluid obtained was pus-like in consistency. The patient's health declined as he experienced increasing temperature and blood pressure and deteriorating mental status. The patient's laboratory results are listed in Table 1.