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The doctor and the mask: iatrogenic septic arthritis caused by Streptoccocus mitis

A 72-year-old man developed septic arthritis in a prosthetic shoulder after intra-articular injection of radiographic contrast. This is the first published case in which molecular techniques matched oral commensal organisms cultured from joint aspirate with oral flora from the proceduralist, who was not wearing a mask.

Clinical record

A 72-year-old man presented in 2011 with acute-on-chronic right shoulder pain. Bilateral shoulder replacements had been performed 8 years earlier for osteoarthritis, with no surgical complications.

In the 6 months before presentation, the patient experienced increasing pain and decreased range of movement of the right shoulder. Four days before presentation, a computed tomography (CT) arthrogram of the right shoulder was performed to look for glenoid osteolysis and assess the linear integrity of the shoulder prosthesis. Eight millilitres of radiographic contrast with bupivacaine were injected into the joint space. The proceduralist used an aseptic technique and skin preparation with 0.5% alcoholic chlorhexidine, but did not wear a mask. Within 24 hours, the shoulder pain dramatically worsened and the range of movement became severely impaired.

The patient had a history of hypertension, severe obstructive…