Giorgetti Arianna, Santelli Simone, Filipuzzi Ilenia, Bonasoni Maria Paola, Basile Giuseppe, Pirani Filippo, Pelotti Susi
Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
Pathology Unit, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
Forensic Sci Med Pathol. 2025 Jan 11. doi: 10.1007/s12024-024-00929-x.
The diagnosis of septic arthritis remains challenging in the clinical setting, often leading to a suspicion for medical liability. Our purpose is to describe an unusual case of a post-mortem diagnosis of P. multocida fatal septic arthritis, in a healthy 67-year-old woman presenting with pain in the right shoulder. Moreover, a literature review of cases of fatal septic arthritis is provided. The multidisciplinary approach consisted of a forensic autopsy and additional post-mortem analyses (microbiology, biochemical analyses, histopathology, and revision of radiological images) carried out during the prosecutor's investigation for medical liability. A systematic review of the literature was performed to collect cases of fatal septic arthritis and to understand its frequency and characteristics. No clear cause of death was determined after the autopsy, that only highlighted swelling and purulent exudation in the right glenohumeral joint. The microbiological swab performed on the shoulder tested positive for P. multocida, while histopathological and biochemical data were consistent with a sepsis. These results guided the interview with the woman's relatives, until a history of a previous contact with a stray cat emerged. The cause of death was deemed as fatal septic arthritis caused by P. multocida, occurred after cat scratches and bites and only diagnosed post-mortem. The review of the literature provided 15 articles about fatal septic arthritis, only 1 caused by P. multocida, and all with ante-mortem diagnosis. Given the nonspecific symptoms, usually including a localized pain, and the absence of a clear history, e.g. of animal contact, septic arthritis might represent an under-reported clinical and pathological diagnosis, leading to a judicial autopsy for the suspicion for medical liability. The post-mortem examination, following a multidisciplinary approach including integration of the clinical history, microbiological and histopathological analysis, could represent the only opportunity for the diagnosis of the cause of death.
在临床环境中，脓毒性关节炎的诊断仍然具有挑战性，常常引发对医疗责任的怀疑。我们的目的是描述一例不寻常的病例，一名67岁健康女性因右肩疼痛就诊，死后诊断为多杀巴斯德菌致死性脓毒性关节炎。此外，还提供了关于致死性脓毒性关节炎病例的文献综述。多学科方法包括法医尸检以及在检察官对医疗责任进行调查期间进行的额外尸检分析（微生物学、生化分析、组织病理学和影像学复查）。进行了文献系统综述，以收集致死性脓毒性关节炎病例并了解其发生率和特征。尸检后未确定明确的死亡原因，仅发现右盂肱关节肿胀和脓性渗出。肩部微生物拭子检测多杀巴斯德菌呈阳性，而组织病理学和生化数据与败血症一致。这些结果指导了对该女性亲属的询问，直到发现她曾与一只流浪猫接触的病史。死亡原因被认为是多杀巴斯德菌引起的致死性脓毒性关节炎，发生在猫抓咬之后，且仅在死后确诊。文献综述提供了15篇关于致死性脓毒性关节炎的文章，只有1例由多杀巴斯德菌引起，且均为生前诊断。鉴于通常包括局部疼痛在内的非特异性症状以及缺乏明确的病史，如动物接触史，脓毒性关节炎可能是一个报告不足的临床和病理诊断，导致因怀疑医疗责任而进行司法尸检。采用包括结合临床病史、微生物学和组织病理学分析在内的多学科方法进行尸检，可能是诊断死亡原因的唯一机会。
