# Streptococcus intermedius Septic Arthritis of the Acromioclavicular Joint with Periarticular Abscesses in an Elderly Man with Diabetes and Recent Canine Exposure: A Case Report and Literature Review

## TL;DR

A rare case of acromioclavicular joint infection caused by Streptococcus intermedius in a diabetic elderly man with recent dog exposure is reported, emphasizing the importance of early diagnosis and treatment.

## Contribution

This case report highlights the rare occurrence of S. intermedius-induced septic arthritis in the acromioclavicular joint and identifies potential risk factors and management strategies.

## Key findings

- MRI revealed periarticular abscesses and osteolysis centered on the acromioclavicular joint.
- Synovial fluid and tissue cultures confirmed high colony counts of Streptococcus intermedius.
- The patient improved after surgical debridement, irrigation, and targeted antibiotic therapy.

## Abstract

Background/Objectives: Streptococcus intermedius, a member of the Streptococcus anginosus group, is characterized by a marked propensity for abscess formation but only rarely causes native-joint septic arthritis. Involvement of the acromioclavicular (AC) joint is particularly uncommon. We describe a case of native AC joint septic arthritis due to S. intermedius in a patient with multiple predisposing factors and highlight diagnostic and management considerations. Methods: We report the clinical course of a 72-year-old man with poorly controlled type 2 diabetes mellitus who presented with progressive right shoulder pain, erythema, and swelling following recurrent minor skin abrasions from a newly adopted dog. Initial management for presumed inflammatory shoulder pathology included brief systemic corticosteroids and an ultrasound-guided intra-articular ketorolac injection. Magnetic resonance imaging (MRI) was performed after symptom progression. The patient underwent operative irrigation and debridement with collection of synovial fluid and deep tissue cultures. Blood cultures and transthoracic echocardiography were obtained to evaluate for systemic involvement. Results: MRI demonstrated multiloculated periarticular abscesses and osteolysis centered on the AC joint. Operative cultures yielded high colony counts of S. intermedius from synovial fluid and deep tissues. Blood cultures and echocardiography were negative. The patient required multiple operative debridements with irrigation, adjunctive local antibiotic therapy, and prolonged targeted β-lactam treatment. Clinical and radiographic improvement was achieved following surgical source control and antimicrobial therapy. Conclusions: Native AC joint septic arthritis due to S. intermedius is rare. Older age, uncontrolled diabetes, recent intra-articular intervention, and possible zoonotic inoculation from canine wound licking may represent contributory risk factors. Early imaging, prompt surgical source control, and guideline-concordant antimicrobial therapy are essential when bone and soft tissue involvement is present.