title: Late hematogenous infection of first metatarsophalangeal joint replacement: a case presentation.
abstract: Late hematogenous infection of previously asymptomatic orthopedic implants is extremely rare and usually associated with total joint replacements, such as those of the hip or knee. We present the case of an otherwise healthy female who developed a deep space infection 18 months after a first metatarsophalangeal joint implant arthroplasty. The patient presented with pain and swelling at the site, and over the course of several days developed fever and tachycardia and leukocytosis. Cultures of the surrounding soft tissues and the implant grew Streptococcus pneumoniae. The patient reported a 1- to 2-week history of symptoms consistent with an upper respiratory tract infection and it is believed that this distant focus of infection was the probable source of late hematogenous seeding of the first metatarsophalangeal joint implant.
authors.affiliation: Presbyterian St. Lukes, Greenwood Village, CO 80218, USA. paulandgailstone@comcast.net
authors.forename: Paul A
authors.initials: PA
authors.lastname: Stone
authors.forename: Esther S
authors.initials: ES
authors.lastname: Barnes
authors.forename: Thomas
authors.initials: T
authors.lastname: Savage
authors.forename: Matthew
authors.initials: M
authors.lastname: Paden
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019643:Arthroplasty, Replacement; D002443:Ceftriaxone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use; D010019:Osteomyelitis / Q000382:microbiology / Q000628:therapy; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000628:therapy; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002443:Ceftriaxone; D015242:Ofloxacin