Cutibacterium acnes Septic Arthritis of the Nonoperated Knee: A Case Report

Abstract

Cutibacterium (Propionibacterium) acnes, a gram-positive bacillus with low pathogenicity, is an uncommon but known cause of prosthetic joint infections, particularly related to shoulder surgery. C. acnes, however, is an extremely rare pathogen in the nonoperated knee joint. This report details an uncommon case of C. acnes septic knee arthritis after multiple intra-articular steroid injections in a 56-year-old male patient. After an indolent presentation and late diagnosis, the patient underwent surgical debridement with IV antibiotic management. This case illustrates that intra-articular corticosteroid injections for the management of osteoarthritis are not without risk. Literature supporting their use remains limited and clinicians should use proficient clinical judgment for appropriate patient selection for these injections. Vigilance following injections or aspirations of the knee should be maintained to identify the indolent clinical presentation of C. acnes septic arthritis.

Keywords

Propionibacterium acnes - Cutibacterium acnes - septic arthritis - intra-articular injection - steroid injection - septic knee - corticosteroid

• References

• 1 Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2005; 2 (02) CD005328
• 2 Charalambous CP, Tryfonidis M, Sadiq S, Hirst P, Paul A. Septic arthritis following intra-articular steroid injection of the knee--a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee. Clin Rheumatol 2003; 22 (06) 386-390
• 3 Dubost JJ, Couderc M, Tatar Z. , et al. Three-decade trends in the distribution of organisms causing septic arthritis in native joints: single-center study of 374 cases. Joint Bone Spine 2014; 81 (05) 438-440
• 4 Barnard E, Nagy I, Hunyadkürti J, Patrick S, McDowell A. Multiplex touchdown PCR for rapid typing of the opportunistic pathogen Propionibacterium acnes . J Clin Microbiol 2015; 53 (04) 1149-1155
• 5 Dodson CC, Craig EV, Cordasco FA. , et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg 2010; 19 (02) 303-307
• 6 Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 2013; 21 (09) 577-579
• 7 Shemesh S, Heller S, Salai M, Velkes S. Septic arthritis of the knee following intraarticular injections in elderly patients: report of six patients. Isr Med Assoc J 2011; 13 (12) 757-760
• 8 Pickup JC, Crook MA. Is type II diabetes mellitus a disease of the innate immune system?. Diabetologia 1998; 41 (10) 1241-1248
• 9 Falagas ME, Kompoti M. Obesity and infection. Lancet Infect Dis 2006; 6 (07) 438-446
• 10 Kooijmans-Coutinho MF, Markusse HM, Dijkmans BA. Infectious arthritis caused by Propionibacterium acnes: a report of two cases. Ann Rheum Dis 1989; 48 (10) 851-852
• 11 Yocum RC, McArthur J, Petty BG, Diehl AM, Moench TR. Septic arthritis caused by Propionibacterium acnes . JAMA 1982; 248 (14) 1740-1741
• 12 Scholz CF, Kilian M. The natural history of cutaneous propionibacteria, and reclassification of selected species within the genus Propionibacterium to the proposed novel genera Acidipropionibacterium gen. nov., Cutibacterium gen. nov. and Pseudopropionibacterium gen. nov. Int J Syst Evol Microbiol 2016; 66 (11) 4422-4432