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An event is serious (FDA MedWatch definition) when the patient outcome is:

  • * death

  • * life-threatening

  • * hospitalisation

  • * disability

  • * congenital anomaly

  • * requires intervention to prevent permanent impairment or damage

A 61-year-old woman developed listerial gastroenteritis complicated by Listeria monocytogenes bacteraemia and prosthetic knee joint infection (PJI) during treatment with prednisolone and fludrocortisone [routes not stated].

The woman, who had a history of Cushing syndrome, had been receiving prednisolone at a daily dose of 5mg and fludrocortisone at a daily dose of 0.1mg. She had undergone total knee replacement arthroplasty of the left knee on 11 January 2008, and of the right knee on 8 August 2012. She was hospitalised on 18 October 2014 due to fever, abdominal pain, and diarrhoea. The fever and diarrhoea begun 2 days prior to the presentation. Peripheral blood and urine cultures were performed.

The woman received treatment with ceftriaxone. She was considered to be immunocompromised. Hence, empirical antimicrobial therapy was initiated. She complained of diarrhoea during first two days of the hospitalisation. On day 3, antibiotic therapy was switched to piperacillin/tazobactam. On the same day, she complained of left knee pain which exacerbated on walking. An examination showed redness and swelling of the left knee with extreme tenderness. Suspicion of PJI was made. An aspirate of the joint fluid showed thick pus like synovial effusion. The laboratory test of the synovial fluid showed: WBC: 27300/mm3 with 79% neutrophils, 6.0% lymphocytes and 15% monocytes, and RBC: 8000/mm3. Based on the analysis of synovial fluid, septic arthritis of the left knee was suspected. The initially performed blood culture revealed L. monocytogenes. Antibiotic therapy was changed to ampicillin, trimethoprim and sulfamethoxazole. A surgical exploration of her left knee was conducted on 23 October 2014 in which pus like effusion released at the site of incision. Synovectomy was carried out. The findings were consistent with PJI. She was thought to have developed Listerial gastroenteritis which further led to Listeria monocytogenes bacteraemia and PJI [durations of treatments to reaction onsets not stated]. On hospital day 5, her fever subsided and she became stable. On day 8, follow up blood culture were negative. She was discharged on amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole. On 7th week of the follow up she was symptomless.

Author comment: "The patient in this study had three of the five above mentioned risk factors (i.e., age, corticosteroid therapy, and diabetes), which are presumed to have led to decreased cellular immunity and listerial gastroenteritis, eventually resulting in bacteremia and PJI."