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[Pasteurella multocida septic arthritis in a native joint: Management dilemmas in a penicillin-allergic patient]

Jeanne Chevalier1, Margot Guedot1, Camelia Frantz1

  • 1Service de rhumatologie, Hôpital national d'instruction des Armées Bégin, Saint-Mandé, France.

La Revue De Medecine Interne
|July 9, 2026
PubMed
Abstract

Insights

Pasteurella multocida septic arthritis in an HIV patient with penicillin allergy requires careful antibiotic selection. Successful treatment involved sequential alternatives like levofloxacin, demonstrating the importance of individualized care.

Area of Science:

  • Infectious Diseases
  • Rheumatology
  • HIV Medicine

Background:

  • Pasteurella multocida is a zoonotic bacterium capable of causing invasive infections, including septic arthritis.
  • Immunocompromised individuals, such as those with HIV, are at higher risk for severe Pasteurella multocida infections.

Purpose of the Study:

  • To report a case of Pasteurella multocida septic arthritis in a patient with HIV and penicillin allergy.
  • To discuss the challenges and strategies for managing such infections.

Main Methods:

  • Case report of a 53-year-old man with HIV presenting with acute wrist arthritis after a cat scratch.
  • Synovial fluid culture identified Pasteurella multocida.
  • Treatment involved sequential antibiotics due to penicillin anaphylaxis, doxycycline intolerance, and trimethoprim-sulfamethoxazole intolerance, ultimately using levofloxacin.

Main Results:

  • The patient recovered fully after six weeks of levofloxacin therapy.
  • Conservative management was successful due to the absence of a drainable collection.
  • The case highlights the need for alternative antibiotic regimens in penicillin-allergic patients.

Conclusions:

  • Managing Pasteurella multocida arthritis in penicillin-allergic HIV patients presents therapeutic challenges.
  • Individualized antibiotic strategies are crucial, especially when facing drug intolerances.
  • Favorable outcomes can be achieved with appropriate antibiotic selection, even without surgical intervention.
Keywords:
Allergie à la pénicillineArthrite septiqueCat scratchGriffure de chatsHIV infectionPasteurella multocidaPenicillin allergySeptic arthritisVIH

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