Septic arthritis and smoldering myeloma

Learning points for cliniciansPneumococcus is a rare causative agent of septic arthritis. The diagnosis of pneumococcal septic arthritis should direct further investigation of systemic immunosuppression. Acquired immunodeficiency including lymphoproliferative disorders and myeloma should be considered in patients with invasive pneumococcal infection, especially in musculoskeletal infections.A 52-year-old woman presented with 5 days history of fever with chills and severe pain of the left wrist and shoulders. Physical examination was notable for swollen left wrist and painful right acromioclavicular joint. Laboratory evaluation revealed elevated inflammation markers [C-reactive protein −39 mg/dl (0–0.5 mg/dl)]. Auto-antibodies against antinuclear, rheumatoid factor, and Anti-cyclic citrullinated peptide were negative. Synovial fluid analysis demonstrated an elevated leukocyte count. Blood and joint fluid cultures were positive for Pneumococcus. The patient was treated with Ceftriaxone intravenously under the diagnosis of Pneumococcal oligoarthritis. Transthoracic echocardiography ruled …