Severe septic arthritis of the shoulder with an axillary nerve lesion in a 4-year-old child

Septic arthritis in children frequently affects the joints of the lower extremity, namely the hip and the knee [1-3]. Infection in the glenohumeral joint is rare [4-7], representing 4% of all joint infections [4, 5]. Arthralgia, joint swelling, fever and pseudoparalysis are the most commonly observed symptoms [1, 4, 5, 8]. Diagnosis and thus appropriate management are often delayed [4] and therefore early disease recognition and treatment play a significant role in minimising the risk of developing complications such as joint surface destruction, growth arrest, adjacent osteomyelitis, and loss of joint movement [1, 4-6]. Brachial plexopathy, is infrequently reported [13], and a lesion to the axillary nerve specifically has not yet been reported in literature to our knowledge. Treatment aims include adequate washout and debridement of the joint with the objective of relieving pain and restoring function [5]. This can be achieved either via arthrotomy or arthroscopically [2, 5]. However there is currently no clear consensus with regard to which management option leads to improved outcome [3, 8], because of the lack of studies describing the results of surgical intervention [9]. The case of a 4-year-old boy with a delayed diagnosis of septic arthritis of the right shoulder with massive abscess formation and an axillary nerve lesion is presented.