# Multiple Pyogenic Arthritis Caused by Edwardsiella tarda Bacteremia: A Case Report and Literature Review

## TL;DR

A rare case of multiple pyogenic arthritis caused by Edwardsiella tarda bacteremia in an elderly man with multiple risk factors was successfully treated with intensive care.

## Contribution

This is the first reported case of multiple pyogenic arthritis caused by Edwardsiella tarda bacteremia.

## Key findings

- The patient developed multiple pyogenic arthritis and septic shock from Edwardsiella tarda bacteremia.
- Intensive care, including antibiotics and surgical debridement, led to clinical improvement.
- Early diagnosis and treatment are crucial for managing severe E. tarda infections in immunocompromised patients.

## Abstract

Infection with Edwardsiella tarda, a Gram-negative rod found in freshwater and seawater, is typically associated with the ingestion of raw fish and commonly causes enteritis, liver abscess, cholangitis, and cholecystitis in humans. However, multiple pyogenic arthritis, which have not been previously reported, are considered exceedingly rare. Herein, we report a case of E. tarda bacteremia that resulted in multiple pyogenic arthritis and septic shock, which was successfully treated with intensive care. An 84-year-old man with a history of prostate cancer, diabetes mellitus, and chronic kidney disease was transferred to our hospital for swelling and pain in the left shoulder, following initial treatment for pyogenic arthritis of the left hip at a previous hospital. Imaging revealed the formation of abscesses in the shoulders and hips. He underwent emergent debridement of the left shoulder abscess and was admitted to the ICU. E. tarda was identified from blood cultures on Day 3 of hospitalization. The patient developed septic shock and required vasopressor support. Intensive care, including the administration of appropriate antibiotics and surgical debridement, yielded clinical improvement. The patient was discharged from the ICU on Day 8. Cases of multiple pyogenic arthritis caused by E. tarda bacteremia have the potential for rapid clinical deterioration. Our patient had multiple risk factors, including cancer, diabetes, and hypertension, which might have predisposed him to a severe disease course. Early diagnosis, appropriate antibiotic therapy, surgical debridement, and intensive care are crucial for patient survival, and early transfer to a tertiary center may improve outcomes. Even rare infections, such as E. tarda, should be considered in the differential diagnosis of immunocompromised patients.