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Acute haematogenous periprosthetic joint infection due to Streptococcus sanguinis along with coexistent crystalline arthropathy after total knee arthroplasty: a rare combination
  1. Joost B Malkus1,2,
  2. Louren M Goedhart2,3 and
  3. Wiebe C Verra2
  1. 1Departmeny of Surgery, Isala Hospitals, Zwolle, The Netherlands
  2. 2Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
  3. 3Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Joost B Malkus; j.malkus{at}


A man in his 60s, with a medical history of gout, underwent total knee arthroplasty of his right knee followed by expeditious rehabilitation. Seven months after surgery, he was referred to the emergency ward with sudden onset of pain and swelling of his right knee accompanied with fever. Further inquiry revealed no trauma, infection or skin lesions besides a tongue bite several weeks earlier. An impaired range motion of the knee was seen on physical examination along with a tachycardia. Laboratory studies showed a C reactive protein of 345 mg/L, after which a debridement, antibiotics and implant retention procedure was performed. Intraoperatively obtained synovial fluid showed monosodium urate crystals consistent with crystalline arthropathy (ie, gout). However, unexpectedly, Streptococcus sanguinis was identified in all microbiological cultures too, confirming a coexistent periprosthetic joint infection. After comprehensive antibiotic treatment and gout flare therapy, this patient made a full recovery with retention of the implant.

  • Bone and joint infections
  • Orthopaedics
  • Rheumatology
  • Orthopaedic and trauma surgery
  • Mouth

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  • Contributors JBM—drafting the work. LMG/WCV—revising critically for important intellectual content. WCV—final approval of the version published.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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