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Streptococcus gordonii septic arthritis of the glenohumeral joint following deltoid intramuscular vaccination
  1. Robert Costigan Flowers1,2,
  2. Beatriz Rivera Rodriguez1,2 and
  3. Kelly Corbitt2
  1. 1Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
  2. 2Internal Medicine, University of Miami Health System, Miami, Florida, USA
  1. Correspondence to Dr Robert Costigan Flowers; robert.flowers{at}jhsmiami.org

Abstract

A 68-year-old woman presented for left shoulder pain, decreased range of motion (ROM) and fever 7 days following COVID-19 vaccination. Investigations showed a tender left deltoid mass, decreased shoulder ROM and elevated inflammatory markers. MRI demonstrated a large glenohumeral effusion with synovitis, and arthrocentesis confirmed septic arthritis (SA). She required subtotal bursectomy. Intraoperative joint cultures grew Streptococcus gordonii. She completed 6 weeks of antibiotics and is undergoing physical therapy for post-infectious adhesive capsulitis. SA is most commonly due to Staphylococcus aureus and β-haemolytic streptococci, and rarely due to viridans group streptococci including S. gordonii. To avoid inadvertent injection into the glenohumeral joint, vaccination should be performed posteriorly and inferiorly into the deltoid musculature. Progressive pain, fever or decreased passive ROM following vaccination should raise concern for SA. Given its rarity, however, concern for secondary SA should not affect the general population’s consideration for vaccination.

  • COVID-19
  • bone and joint infections
  • vaccination/immunisation
  • orthopaedics
  • rheumatology

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Footnotes

  • Contributors RCF: Wrote sections of the case report, primary resident for the case patient. BRR: Wrote sections of the case report, primary intern for the case patient. KC: Made critical edits to the case report, primary attending physician for the case patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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