# Diagnostic and Treatment Challenges in the Clinical Curing of MRSA Coxitis in a Tetraplegic Immunocompromised Patient: A Case Report and Literature Review

## TL;DR

This case report describes the challenges of diagnosing and treating MRSA-induced hip joint infection in a patient with HIV and tetraplegia.

## Contribution

The paper presents a rare case of MRSA coxitis in an immunocompromised tetraplegic patient, highlighting diagnostic and therapeutic challenges.

## Key findings

- MRSA-induced coxitis in an HIV-positive tetraplegic patient was diagnosed through blood culture despite negative synovial fluid cultures.
- Combined antimicrobial therapy and surgical debridement led to clinical improvement in the patient.
- The case underscores the need for early imaging and multidisciplinary care in diagnosing septic arthritis in immunosuppressed patients.

## Abstract

Background/Objective: Coxitis is an inflammation of the hip joint, often resulting in pain and functional decline. It can be caused by various factors, including avascular necrosis, trauma, and infection. Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat due to its resistance profile and destructive potential. To the best of our knowledge, there are limited studies on MRSA-induced purulent coxitis, specifically in patients with human immunodeficiency virus (HIV) and tetraplegia, making this case particularly valuable for expanding the understanding of this rare and complicated condition. The aim is to describe the clinical presentation, diagnostic workup, antimicrobial management, surgical intervention, and follow-up of a patient with an atypical hip joint infection. A brief literature review is also provided. Case Report: We report a case of suppurative coxitis caused by MRSA in a 38-year-old man with HIV disease and post-traumatic tetraplegia, which posed significant diagnostic and therapeutic challenges. The patient was diagnosed with MRSA bacteremia and suppurative coxitis after extensive work-up. Synovial fluid cultures were negative, likely due to previous antibiotic use. Targeted antimicrobial therapy was initiated based on blood culture and susceptibility testing. Surgical debridement and femoral head resection were performed. The patient showed progressive clinical and biochemical improvement with combined antimicrobial and surgical therapy. Conclusions: This case highlights the difficulty in diagnosing septic arthritis in patients with neurological disorders and immunosuppression, especially in the absence of classic symptoms. It emphasizes the importance of multidisciplinary care and early imaging in patients with persistent fever and unclear source of infection.