Abstract
We recently experienced a case of a seventy-two year old male who had been admitted for ileus to the department of surgery of our hospital. His ileus was treated conservatively by intravenous hyperalimentation (IVH). Fourteen days after the IVH his temperature rose to over 38.0°C. From the next dad he suffered pain in his right shoulder. There was a maximal tenderness and swelling on his right acromioclavicular joint. Laboratory studies showed a white blood cell count of 12, 500/mm3, and CRP of 16. 75mg/dl. Roentgenograms showed widening and erosion of the acromioclavicular joint. We immediately administered intravenous antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the blood culture. The inflammation spread to the anterior aspect of his right shoulder. Formation of a subdeltoid bursa abscess was recognized with MRI. On the nineth day from onset, we drained the abscess. 99mTechnetium pyrophosphate bone scanning showed an accumulation in his right acromioclavicular joint. At the thirty-first day from onset, we performed a resection arthroplasty of the acromioclavicular joint. MRSA was found in the joint. Soon after the surgery, the pain and fever subsided and laboratory studies showed no inflammation. After four months from onset there were no further signs of inflammation, and he reported only a slight pain in his right shoulder. The range of moton of his right shoulder was almost normal, and the function was not restrictrd. we speculate that catheter related septicemia developed into septic arthritis of the acromioclavicular joint.
