Septic arthritis due to Corynebacterium striatum in native joints: a systematic review of published cases

Corynebacterium striatum has traditionally been regarded as a skin commensal and is frequently dismissed as a contaminant when isolated from clinical samples. However, it has increasingly been recognized as an opportunistic pathogen in selected clinical settings. Septic arthritis involving native joints remains an exceptionally rare manifestation, and its clinical significance is often difficult to interpret.

Given the absence of comprehensive analyses in this field, we performed a systematic literature review of published cases of septic arthritis caused by C. striatum involving native joints, in accordance with PRISMA 2020 guidelines. Demographic data, risk factors, clinical presentation, microbiological findings, management strategies, and outcomes were reviewed. A contemporary case was included as part of the overall analysis.

Twelve cases were identified. Most patients presented with acute monoarticular arthritis affecting large joints, particularly the knee and shoulder. Predisposing factors were present in nearly all cases, including advanced age, immunosuppression, underlying joint disease, or recent joint manipulation. Synovial fluid analysis consistently demonstrated a marked inflammatory profile. Repeated isolation of C. striatum from sterile joint samples supported its etiologic role. Management commonly included surgical irrigation and debridement combined with prolonged antimicrobial therapy, most frequently vancomycin. Overall outcomes were generally favourable, although severe complications were reported in patients with significant comorbidities. These findings identify consistent clinical and therapeutic patterns despite the rarity of the condition.

Corynebacterium striatum should be considered a potential cause of septic arthritis in native joints, particularly in high-risk patients. Its clinical presentation is largely indistinguishable from that of septic arthritis caused by more common bacterial pathogens, and diagnosis relies on repeated isolation from sterile synovial samples in the context of a markedly inflammatory synovial profile. Early surgical drainage combined with targeted prolonged antimicrobial therapy, most commonly vancomycin with oral linezolid step-down when susceptible, appears to represent the most consistently supported management strategy based on available evidence. Recognition of its pathogenic potential is essential to avoid misclassification as contamination, prevent delayed diagnosis and suboptimal treatment, and ultimately improve clinical outcomes in this emerging clinical entity.