CASE REPORT
Septic Arthritis Due to Streptococcus sanguis

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We report an unusual case of septic arthritis due to Streptococcus sanguis, a member of the viridans group of streptococci that are part of the normal flora of the mouth and upper respiratory tract. Our patient had severe underlying periodontal disease, which likely contributed to his joint sepsis through hematogenous spread. Although viridans streptococci are rare causes of septic arthritis in native joints, they should be considered in the setting of severe periodontal disease.

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REPORT OF A CASE

A 66-year-old man was admitted to the hospital on July 27, 1997, because of increasing swelling and erythema of the right knee and leg. He had a history of degenerative joint disease with pain in the right knee of several years’ duration. Seventeen days before admission, the patient experienced swelling of the right knee, and 4 days later an arthrocentesis was performed, which showed 24 × 109/L white blood cells (predominantly polymorphonuclear). Direct examination for crystals was negative.

DISCUSSION

S sanguis, a member of the viridans group of streptococci, is part of the normal flora of the mouth and upper respiratory tract in humans.6, 7, 8, 9, 10 These organisms are traditionally considered of low virulence, lacking exotoxins that characterize the hemolytic streptococci. Septic arthritis due to viridans group streptococci in general and S sanguis in particular has been reported only rarely. Two comprehensive reviews of the topic do not mention viridans group streptococci as etiologic

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