# Severe Diverticulitis With Streptococcus anginosus Bacteremia Complicated by Native Hip Septic Arthritis and Subacromial Bursitis

## TL;DR

A 38-year-old man with severe diverticulitis and Streptococcus anginosus bacteremia developed hip and shoulder infections, highlighting the bacteria's ability to cause musculoskeletal issues.

## Contribution

This case report demonstrates Streptococcus anginosus as a rare cause of native hip septic arthritis and subacromial bursitis.

## Key findings

- Streptococcus anginosus was isolated from hepatic abscesses, hip joint fluid, and likely subacromial bursitis.
- The patient's musculoskeletal infections resolved after surgical lavage and four weeks of antibiotics.
- The case expands the known clinical spectrum of Streptococcus anginosus infections to include native joint and bursa involvement.

## Abstract

A 38-year-old man was admitted for severe diverticulitis complicated by Streptococcus anginosus bacteremia. A CT of the abdomen and pelvis on admission was significant for the additional finding of several hepatic abscesses and a small left hip effusion. On examination, the passive and active range of motion of his left hip and shoulder was limited and painful. A hepatic abscess drain was placed, with aspirate cultures yielding Streptococcus anginosus. Additionally, a left hip arthrocentesis was performed with cultures yielding Streptococcus anginosus. A left shoulder arthrocentesis did not yield any fluid; however, an MRI was relevant for synovial thickening with septation of an enlarged subacromial bursa, suggestive of subacromial bursitis. The patient underwent an arthrotomy with lavage of the left hip joint and completed a four-week course of antibiotic therapy with resolution of the infection and hip and shoulder pain. This is a case describing Streptococcus anginosus, an organism typically associated with pyogenic infections, causing native hip septic arthritis and probable septic subacromial bursitis. This highlights Streptococcus anginosus' potential to cause musculoskeletal infections.