Streptococcus gordonii septic arthritis of the glenohumeral joint following deltoid intramuscular vaccination

A 68-year-old woman presented for left shoulder pain, decreased range of motion (ROM) and fever 7 days following COVID-19 vaccination. Investigations showed a tender left deltoid mass, decreased shoulder ROM and elevated inflammatory markers. MRI demonstrated a large glenohumeral effusion with synovitis, and arthrocentesis confirmed septic arthritis (SA). She required subtotal bursectomy. Intraoperative joint cultures grew Streptococcus gordonii. She completed 6 weeks of antibiotics and is undergoing physical therapy for post-infectious adhesive capsulitis. SA is most commonly due to Staphylococcus aureus and beta-haemolytic streptococci, and rarely due to viridans group streptococci including S. gordonii. To avoid inadvertent injection into the glenohumeral joint, vaccination should be performed posteriorly and inferiorly into the deltoid musculature. Progressive pain, fever or decreased passive ROM following vaccination should raise concern for SA. Given its rarity, however, concern for secondary SA should not affect the general population's consideration for vaccination.

Automated summary

A 68-year-old female presented with left shoulder pain, decreased ROM, and fever following COVID-19 vaccination. Investigations revealed septic arthritis due to Streptococcus gordonii. Proper vaccination technique should be followed to avoid complications. Symptoms such as pain, fever, and decreased ROM following vaccination should raise suspicion for septic arthritis.