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21


An uncommon presentation of streptococcus pneumoniae [Meeting Abstract]

Vani, A; Su, M H M; Cocks, P M
LEARNING OBJECTIVE #1: Describe the mechanism of septic arthritis LEARNINGOBJECTIVE #2: Recognize the epidemiology, risk factors, and prognosis of patients with septic arthritis caused by Streptococcus pneumoniae CASE: A 43 year-old man with a history of Hodgkin's Lymphoma, treated with chemotherapy and radiation, complicated by avascular necrosis requiring bilateral hip replacements, and myelodysplastic syndrome requiring a splenectomy and stem cell transplant, presented with one month of productive cough, two days of myalgias, and acute on chronic bilateral shoulder and hip pain. On presentation to our institution, he was found to have profound leukocytosis with neutrophilia and bandemia and a computed tomography of the chest suggestive of a multi-lobar pneumonia. His physical exam was remarkable for a high fever, rigors, diminished breath sounds at the lung bases, and decreased range of motion in his right lower extremity due to right hip pain. He was treated empirically with intravenous vancomycin and piperacillin-tazobactam. Blood cultures grew pan-sensitive S. pneumoniae and his antibiotics were narrowed to intravenous ceftriaxone. His hospital course was complicated by persistent leukocytosis, fevers, and right hip pain. Magnetic resonance imaging and a gallium nuclear scan were performed, which suggested infection of his right hip. He underwent an arthrocentesis followed by a right hip wash out without prosthesis removal. He was discharged home on an extended course of antibiotics with resolution of his leukocytosis, fevers, and right hip pain. IMPACT: Our case highlights a relatively uncommon phenomenon, which is septic arthritis caused by S. pneumoniae. Clinicians should be aware of predisposing factors that place patients at risk for developing a joint infection from this organism. DISCUSSION: Septic arthritis occurs via bacterial invasion of the synovial membrane, most commonly by hematogenous spread, leading to an acute inflammatory response involving synovial membrane hyperplasia, local cytokine production, and cartilage destruction. Several studies report a widely disparate prevalence of septic arthritis caused by S. pneumoniae, with most studies reporting a low single digit prevalence. While relatively uncommon, S. pneumoniae arthritis should be considered in patients with extra-articular infections, such as pneumonia or meningitis, and predisposing factors, which include alcoholism, rheumatoid arthritis, immunosuppression, splenectomy, preexisting joint disease, or patients with prosthetic joints. Prosthetic joints pose a fifteen-time greater risk of infection by providing a surface for S. pneumoniae to multiply and form biofilms to defend against circulating leukocytes, complement, and antibiotics. Good functional outcome is seen in the majority of patients treated with appropriate antibiotic therapy and surgical intervention, and often patients with prostheses do not require removal
EMBASE:615582147
ISSN: 0884-8734
CID: 2553752

FALLING ON OUTSTRETCHED HANDS: THINKING OUTSIDE THE SNUFFBOX [Meeting Abstract]

Ma, Helen; Cheng, David; Cocks, Patrick M
ISI:000392201602214
ISSN: 1525-1497
CID: 2481912

RESIDENCY WELLNESS: CHANGING CULTURE THROUGH EXPERIENTIAL LEARNING [Meeting Abstract]

Horlick, Margaret; Cocks, Patrick M; Altshuler, Lisa; Gillespie, Colleen; Zabar, Sondra
ISI:000392201603238
ISSN: 1525-1497
CID: 2482012

INTERVENTIONS TO PROMOTE RESIDENT WELLNESS: A NATIONAL SURVEY OF RESIDENCY PROGRAM DIRECTORS [Meeting Abstract]

Bhagat, Rajiv; Cocks, Patrick M; Vorsanger, Matthew
ISI:000392201600351
ISSN: 1525-1497
CID: 2482062

Teaching medical students in English in a non-English speaking country: evaluation of a global health elective for US residents in Turkey [Meeting Abstract]

Bertelsen, N. S.; Cocks, P.; Demirhan, M.
ISI:000360758802289
ISSN: 1360-2276
CID: 2941562

CALLING IT LIKE YOU SEE IT: THREE-HOUR WORKSHOP IMPROVES HOSPITALISTS OBSERVATION AND FEEDBACK SKILLS [Meeting Abstract]

Horlick, Margaret; Miller, Louis H; Cocks, Patrick M; Bui, Lynn; Schwartz, Mark D; Dembitzer, Anne
ISI:000358386900162
ISSN: 1525-1497
CID: 1730022

CHANGING THE CULTURE OF BEDSIDE TEACHING: MASTER CLINICIAN AND JUNIOR FACULTY PARTNERSHIP [Meeting Abstract]

Altshuler, Lisa; Bails, Douglas; Carrington, Adam; Cocks, Patrick M; Schiliro, Danise; Schaye, Verity; Wagner, Ellen; Zabar, Sondra; Janjigian, Michael
ISI:000358386900021
ISSN: 1525-1497
CID: 1730252

RECURRENT DAPSONE HYPERSENSITIVITY SYNDROME IN AN HLA-B*13:01-POSTIVE INDIVIDUAL WITH OCCULT MYCOBACTERIUM MARINUM INFECTION [Meeting Abstract]

Levine, David M; Akiyama, Matthew; Chen, Xian Jie (Cindy); Esaian, Diana; Jindal, Neha; Vinh Pham; Cocks, Patrick M
ISI:000358386901566
ISSN: 1525-1497
CID: 1730332

DEVELOPMENT OF A BEDSIDE TEACHING SERVICE TO ENHANCE PHYSICAL EXAMINATION AND CLINICAL REASONING SKILLS [Meeting Abstract]

Altshuler, Lisa; Schiliro, Danise; Bails, Douglas; Cocks, Patrick M; Cogen, Ellen; Fernandez, Jesenia; Horlick, Margaret; Janjigian, Michael; Miller, Louis H; Perel, Valerie; Zabar, Sondra
ISI:000340996203106
ISSN: 1525-1497
CID: 1268162

PERCEPTIONS OF INTERVAL MEDICINE RESIDENTS ON SUDDEN DISRUPTIONS TO THEIR TRAINING: A STUDY OF HURRICANE SANDY [Meeting Abstract]

Yang, Shaun K; Fang, Yixin; Cocks, Patrick M
ISI:000340996201040
ISSN: 1525-1497
CID: 1268062