C. burnetii-associated culture-negative septic arthritis of a native knee in a dialyzed patient
Abstract
Coxiella burnetii is a rare cause of osteoarticular infection and may be overlooked in patients with culture-negative septic arthritis. We report the case of an 82-year-old man affected by diabetes mellitus and end-stage renal disease on chronic hemodialysis who presented with a 2-day history of knee pain and fever. Synovial fluid analysis showed 86,460 white blood cells/µL with 95% polymorphonuclear cells, highly suggestive of septic arthritis. A multiplex molecular panel on synovial fluid was negative, as were routine cultures from arthrocentesis and intraoperative samples obtained during arthroscopic lavage. Empirical postoperative treatment with vancomycin and levofloxacin was started. Because of the culture-negative setting, serological testing for atypical pathogens was performed 10 days later and showed IgG positivity for Coxiella burnetii. The patient lived in a rural environment, making zoonotic exposure plausible. Therapy was switched to doxycycline and moxifloxacin, with complete clinical remission. This case highlights the diagnostic challenge of Coxiella-associated osteoarticular infection and the need to consider atypical zoonotic pathogens in selected cases of culture-negative septic arthritis.
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© © Ortopedici Traumatologi Ospedalieri d’Italia (O.T.O.D.i.) , 2026
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