Septic arthritis of the shoulder caused by E. coli infection in a premature infant

We present the case of a premature infant 33 weeks of gestational age and 1600 g, that had required intensive care at a tertiary hospital due to refractory pulmonary hipertensión and multiorganic illness, at his return to our center, at 37 weeks of corrected gestational age, with a peripheral line in his right axilla, presents with frequent apneas and feeding intolerance.

The initial presentation is subacute and unspecific, with discrete alterations in his blood tests, but progressively starts with inflammatory signs, pain and shoulder movement limitations. Septic arthritis is diagnosed after revealing joint effusion by ultrasonography and obtaining synovial fluid with purulent characteristics by needle aspiration. He was started on empiric intravenous antibiotics that were later adjusted according to the antibiogram once the results for the synovial fluid culture turned positive for E. coli.

Clinical recovery was slow at first, but clearly improved throughout a three week intravenous antibiotic course, and the infant did not need open surgery. At discharge, there was an almost full recovery in terms of movement range of the shoulder and he was pain free. The infant completed another three weeks of oral antibiotics with cefuroxime-axetile. Ongoing follow-up yielded excellent results.