Reactions 1871, p135 - 4 Sep 2021

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Reactions 1871, p135 - 4 Sep 2021

Covid-19-vaccine-Pfizer-BioNTech S Septic arthritis: case report

A 68-year-old woman developed septic arthritis following vaccination with Covid-19-vaccine-Pfizer-BioNTech.

The woman, who had a history of hyperlipidaemia, diverticulitis and hypertension, presented to the emergency department with dull left shoulder pain and reduced range of motion. Three days before the presentation, she received Covid-19-vaccine-Pfizer- BioNTech using VanishPoint 1mL syringe with a retractable hypodermic 25 gauge (G) 1-inch needle or a BD Eclipse 25G 1-inch needle. She was discharged from the hospital with a physical examination and unremarkable history with a diagnosis of expected postvaccination pain. After 4 days, she returned to the emergency department with severe progressive left shoulder pain and a reduced range of motion. Vital signs test showed an oral temperature of 37.3°C with subjective chills. No history of respiratory or urinary symptoms or trauma to the area was reported. No acute distress was observed. An examination of the left shoulder showed moderate oedema and warmth at the anterolateral deltoid. The passive range of motion of her left shoulder was limited due to pain.

Her active range of motion was also severely limited because of pain. Her neurovascular examination was non-significant.

Laboratory test results were as follows: WBC count: 9100 cells/µL, ESR: 60 mm/hr and CRP: 24.2 mg/dL. Radiographs of the left shoulder showed no osseous abnormality. The MRI of the left shoulder showed severe subdeltoid/ subacromial bursitis with distention of the subdeltoid component with a huge amount of fluid and a full-thickness rotator cuff tear through the midportion of the supraspinatus. Also, significant thickening and enhancement of the synovium indicated septic bursitis and arthritis. Hence, the glenohumeral joint aspiration was done, and cloudy synovial fluid was aspirated with cell count remarkable for 95% neutrophils, 130000 WBCs/µL and fluid glucose 61 mg/dL. Her findings were consistent with left glenohumeral joint septic arthritis and left shoulder septic bursitis.

Hence, the woman underwent left shoulder irrigation and debridement under general anaesthesia. The anterior aspect of the left shoulder showed significant oedema without erythema. Her subacromial bursa was enlarged and inflamed. After incision through the bursal tissue, remarkable necrotic debris, seropurulent fluid and expressible purulence was released. Her bursal tissue was considerably inflamed and excised. The joint capsule was incised, followed by the removal of cloudy synovial fluid from the glenohumeral joint. Following irrigation and debridement of the glenohumeral joint, her surgical wound closed. She remained hospitalised postoperatively and was treated with vancomycin and ceftriaxone. Afterwards, cultures showed positive results for preoperative synovial aspiration growing Streptococcus viridans, intraoperative glenohumeral joint swab growing Streptococcus gordonii and a second swab growing Mycelia sterilia. Also, negative cultures included 3 intraoperative fungus cultures, 2 bursa/

synovial swabs, 2 preoperative blood cultures and 1 bursa/synovial specimen. As per infectious disease recommendations, she remained on IV ceftriaxone for one week, and then switched to oral antibiotics for 3 weeks after discharged from the hospital. Based on findings, a diagnosis of septic arthritis due to Covid-19-vaccine-Pfizer-BioNTech was confirmed.

Massel DH, et al. Septic Arthritis of the Shoulder After SARS-CoV-2 Pfizer Vaccination: A Case Report. JBJS Case Connector 11: No. 3, 30 Jul 2021. Available from: URL:

http://doi.org/10.2106/JBJS.CC.21.00090 803592090