Case Study

Post-procedural Bacillus cereus septic arthritis in a patient with systemic lupus erythematosus

Barend Mitton, Roxanne Rule, Nontombi Mbelle, Wesley van Hougenhouck-Tulleken, Mohamed Said
African Journal of Laboratory Medicine | Vol 9, No 1 | a1119 | DOI: https://doi.org/10.4102/ajlm.v9i1.1119 | © 2020 Barend Mitton, Roxanne Rule, Nontombi Mbelle, Wesley van Hougenhouck-Tulleken, Mohamed Said | This work is licensed under CC Attribution 4.0
Submitted: 06 November 2019 | Published: 20 August 2020

About the author(s)

Barend Mitton, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; and, Tshwane Academic Division, Department of Medical Microbiology, National Health Laboratory Service, Pretoria, South Africa
Roxanne Rule, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; and, Tshwane Academic Division, Department of Medical Microbiology, National Health Laboratory Service, Pretoria, South Africa
Nontombi Mbelle, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; and, Tshwane Academic Division, Department of Medical Microbiology, National Health Laboratory Service, Pretoria, South Africa
Wesley van Hougenhouck-Tulleken, Division of Nephrology, Department of Internal Medicine, University of Pretoria, Pretoria, South Africa; and, Department of Internal Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
Mohamed Said, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; and, Tshwane Academic Division, Department of Medical Microbiology, National Health Laboratory Service, Pretoria, South Africa


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Abstract

Introduction: Bacillus species are often considered as contaminants when cultured from clinical samples. Bacillus cereus may be a pathogen in certain circumstances and is known to cause musculoskeletal infections. This report aims to educate clinicians and clinical microbiology laboratories on B. cereus musculoskeletal infections and to heighten awareness that Bacillus species should not always be dismissed as contaminants.

Case presentation: We report the case of a patient who presented to a tertiary hospital in Pretoria, South Africa, in November 2018 with B. cereus septic arthritis and underlying systemic lupus erythematosus (SLE). The isolate would otherwise have been dismissed as a contaminant had it not been for the crucial interaction between the laboratory and the treating clinicians. To our knowledge, this is the first case report of septic arthritis caused by B. cereus in an SLE patient where the organism was cultured from the joint specimen. Identification of the organism was performed using matrix-assisted laser desorption/ionisation mass spectrometry.

Management and outcome: Definitive treatment was with intravenous vancomycin, continued for four weeks, in addition to arthroscopy and management of the underlying SLE. The patient had a good clinical outcome and regained full mobility.

Conclusion: Musculoskeletal infections, specifically septic arthritis caused by B. cereus, are exceedingly rare infections. Immune suppression, trauma, prosthetic implants and invasive procedures are important risk factors for B. cereus musculoskeletal infections. Close collaboration with a multi-disciplinary team approach will effect the best outcome for complicated patients with B. cereus infections.


Keywords

Bacillus cereus; septic arthritis; systemic lupus erythematosus; Matrix-assisted laser desorption/ionisation mass spectrometry; MALDI-TOF MS; musculoskeletal infection; arthroscopy

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