Septic Arthritis Secondary to Acupuncture in an Immunocompromised Patient With Multiple Comorbid Conditions

BACKGROUND Acupuncture-related infection can result from use of unsterilized or used needles, inadequate skin disinfection, or contact between needles and contaminated surfaces. Immunocompromised patients are at increased risk for opportunistic infection and further complications. We present the case of a Staphylococcus epidermidis infection related to acupuncture in a 69-year-old man on immunosuppressive therapy for multiple myeloma. CASE REPORT A 69-year-old man with acute-on-chronic left shoulder pain was evaluated at our Emergency Department after recent acupuncture treatments. He was undergoing chemotherapy for relapsed multiple myeloma, which developed 14 years after a stem cell transplant. Upon admission, a large collection of fluid was identified in his left shoulder bursa, prompting consultation with an orthopedic surgeon and the aspiration of fluid, which contained a total white blood cell count of 91 560 cells/µL and absolute neutrophil count of 85 150 cells/µL. Treatment with intravenous ceftazidime and vancomycin was initiated, followed by surgical irrigation and debridement. Infectious Disease specialists added metronidazole. Cultures of excess fluid from the surgical site grew S. epidermidis, which was linked to his acupuncture treatments. The patient was discharged home to complete antibiotic therapy but was readmitted due to vancomycin-related acute kidney injury, fluid overload, and heart failure exacerbation, requiring further care. CONCLUSIONS Our patient's septic arthritis, presumed to be secondary to acupuncture therapy, underscores the risks associated with alternative medicine practices as potential sources of serious infections in immunocompromised patients. It also highlights the importance of using a multidisciplinary approach to successfully manage complex cases involving infectious and noninfectious complications.