gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Propionibacterium acnes infection: a first reported case in the native wrist joint

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  • presenting/speaker Andrew Mckean - Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
  • Angelos Assiotis - Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
  • Sami Hassan - Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
  • Michael Elvey - Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
  • Luke Moore - Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
  • Rupert Eckersley - Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1521

doi: 10.3205/19ifssh0160, urn:nbn:de:0183-19ifssh01600

Published: February 6, 2020

© 2020 Mckean et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Propionibacterium acnes (P. acnes) is an anaerobic organism that commonly colonizes the human skin. It is the most prevalent organism associated with deep prosthetic shoulder joint infections. It has never been implicated in rapidly progressive arthritis of the native wrist joint.

Methods: A 59-year-old retired, right hand dominant office worker was referred with a 6-week history of progressive pain and swelling in her left wrist after multiple local healthcare visits. There was no history of preceding trauma, foreign travel and tuberculosis contacts. She was systemically well and denied any constitutional symptoms. Clinical examination found pain on palpation over the radiocarpal and distal radioulnar joints, with diffuse swelling over the dorsum of her wrist, and an exaggerated pain response to both active and passive range of movement.

Serial radiographs showed rapidly progressive degenerative changes within the wrist along with raised inflammatory markers suggesting possible underlying infection. She underwent urgent exploration, washout and bone/synovial biopsies for microbiology and histological analysis prior to administration of antibiotics. Prolonged enrichment culture specimens grew P. acnes. Fungal cultures, acid alcohol fast bacilli cultures and histopathology were all unremarkable. She was commenced on 6 weeks of oral co-trimoxazole. Her acute symptoms and inflammatory markers improved.

Results and Conclusions: We describe a case of rapidly progressive arthropathy of the native wrist secondary to infection with P. acnes. This is the first time this has been described in the literature. It is imperative to request and wait for prolonged enrichment cultures to aid microbiological diagnosis.