Thread by @IUIDfellowship

#idboardreview 60 F with Myelodysplastic syndrome presents w/ L knee pain, rash on unilateral sole, PET: L iliac artery uptake. Knee fluid 80k 98% PMN, gram stain gram negative cocobacilli. dx? #meded #idmeded #idtwitter

Endovascular Infection #Kingella #kingae Complicated by Septic Arthritis in Immunocompromised Adult Patient Ref wwwnc.cdc.gov/eid/article/26…

#Kingella kingae gram-negative coccobacillus,normal flora of upper respiratory tract. Causative agent of osteoartricular infections in kids<4 years. Rarely HACEK IE in adults
R.f poor oral hygiene, pharyngitis, & mucosal ulcerations

#Kingella kingae adult IE, native or prosthetic valves. Clear oral source for the invasive infection in some cases. After transient bacteremia, the pathogen seeds heart valves that have damaged endothelium.

In this case: septic arthritis seemed to have been a complication of infected vascular lesion in femoral artery, caused either by seeding after bacteremia or after septic emboli to L leg, including knee & skin of sole of foot

In the absence of endocarditis, slow clinical improvement of septic arthritis #Kingella kingae should raise suspicion of a deep-seated infections as endovascular source, especially for patients with risk factors for atherosclerosis, such as a history of smoking #iddailypearl