38-year-old woman with septic arthritis and retroperitoneal abscess after intraarticular corticosteroid injection: A case report

Abstract

Septic arthritis (SA) is an uncommon condition in which a pathogen invades a joint. SA presents clinically with monoarticular joint pain, swelling, and fever. Computed tomography and magnetic resonance imaging are common diagnostic modalities for SA in conjunction with lab work such as white blood cell count. SA is typically treated by joint drainage and antibiotics and is associated with poor outcomes. A 38-year-old woman with 3 prior arthroscopies over a seven-year period presented with an unresolved eight-year history of sharp intermittent pain in the groin and lateral hip. She was referred for nonsurgical treatment of her pain and received 2 corticosteroid hip injections. Subsequently following the injection, the patient developed fever, chills, and a mottled rash over her hip. Magnetic resonance imaging and inflammatory markers were obtained. Osteomyelitis with septic arthritis of the right hip with extension into the retroperitoneum was confirmed. The patient underwent resection arthroplasty with open retroperitoneal decompression of the iliopsoas abscess. Cultures isolated Staphylococcus aureus. Subsequent staged articulating hip spacer followed by reimplantation with total hip arthroplasty were performed. The patient had significant improvement as measured by patient reported outcomes scores. This case report describes a unique case of hip septic arthritis, with retroperitoneal abscess post-intra articular injection, that resulted in subsequent open retroperitoneal incision and debridement followed by two-stage resection arthroplasty with articulating spacer and total hip arthroplasty.