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He had a history of chronic obstructive pulmonary disease &#40;COPD&#41;&#44; chronic atrial fibrillation and left nephrectomy&#46; He had been admitted 5 months earlier for acute monoarthritis of left knee with microcrystalline disease &#40;calcium pyrophosphate&#41;&#44; and required arthrocentesis and anti-inflammatory agents&#46; Since then&#44; he had had an indolent course&#44; with slight intermittent fever and impaired function&#44; reasons for which he was reevaluated&#46; On admission he had inflammatory signs in left knee&#44; C-reactive protein 72<span class="elsevierStyleHsp" style=""></span>mg&#47;L and arthrocentesis yielded a fluid containing blood and pus&#44; the glucose level was 3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and proteins 4&#46;4<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#59; cell count could not be performed&#46; Given the suspicion of the presence of infectious arthritis&#44; we decided to perform surgical joint lavage&#46; In cultures of the fluid from arthrocentesis and in intraoperative specimens&#44; we isolated <span class="elsevierStyleItalic">C&#46; striatum</span>&#44; which is resistant to penicillins&#44; clindamycin and quinolones&#44; whereas it is sensitive to vancomycin&#44; linezolid and rifampicin&#46; It was decided to treat him with intravenous linezolid &#40;600<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41; as the patient had only 1 kidney&#46; After a week&#44; the patient developed gastrointestinal toxicity&#44; and the arthritis persisted&#46; Thus&#44; we replaced linezolid with teicoplanin &#40;600&#8211;800<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41; and he underwent a second surgical lavage&#46; After a number of determinations&#44; therapeutic levels were not being achieved&#46; Therefore&#44; we decided to treat him with dalbavancin in a single dose of 1500<span class="elsevierStyleHsp" style=""></span>mg after confirming sensitivity by means of an E-test<span class="elsevierStyleSup">&#174;</span> &#40;minimum inhibitory concentration &#60;0&#46;125<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL&#41;&#46; After that treatment&#44; the patient began to show clinical and analytical improvement&#44; and we decided to discharge him 7 days later&#46; The patient was followed in the outpatient clinic for 6 months&#44; with no signs of reactivation&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Corynebacterium</span> is a genus of facultative anaerobic Gram-positive bacilli&#46; With the exception of <span class="elsevierStyleItalic">C&#46; diphtheriae</span>&#44; the rest of the species are saprophytes of the skin and mucosae&#44; and are considered common contaminants&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Their repeated isolation in relation to medical devices and in patients in whom infection is suspected signifies that they are considered a pathogen&#46; <span class="elsevierStyleItalic">C&#46; striatum</span> has been implicated in endocarditis&#44; pneumonias and osteoarticular infections&#46; They are usually resistant to diverse groups of antibiotics but&#44; basically&#44; continue to be sensitive to glycopeptides&#44; linezolid and imipenem&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In a review of the literature&#44; we found 4 cases of infection in native joints by <span class="elsevierStyleItalic">C&#46; striatum</span> and only 2 cases with genicular involvement&#46; Westblade et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> described a patient with acute arthritis of the knee produced by <span class="elsevierStyleItalic">C&#46; striatum</span> with a positive outcome after 4 weeks of treatment with intravenous vancomycin&#46; Scholle<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> reported another case of arthritis of the knee treated for 2 weeks with intravenous vancomycin&#46; Both of these cases developed after a previous traumatic injury affecting the joint&#46; Cone et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> described the case of a patient with arthritis of the elbow secondary to an accidental injury with a scalpel during an intervention&#44; that was treated with vancomycin for 10 days&#44; followed by ciprofloxacin for 7 days&#46; Finally&#44; Feced Olmos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> published a case of arthritis of the shoulder that developed after corticosteroid injection&#44; and improved after 15 days of treatment with ceftriaxone&#46; In the case we report here&#44; aside from factors known to have a role in immunosuppression&#44; such as advanced age and COPD&#44; we suspect&#44; as a probable additional risk factor&#44; the fact that the patient had undergone arthrocentesis&#44; as well as arthritis due to calcium pyrophosphate deposition&#44; which could&#44; in turn&#44; contribute to the development of septic arthritis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Dalbavancin is a semisynthetic lipoglycopeptide&#44; derived from teicoplanin&#46; It is a bactericide and time-dependent&#44; and acts by inhibiting the formation of the bacterial wall&#44; with a spectrum of activity against methicillin-susceptible and methicillin-resistant Gram-positive pathogens&#44; as well as intermediate susceptibility to vancomycin&#46; It is also effective against certain Gram-positive anaerobic pathogens&#46; It is not active against enterococci expressing the VanA gene&#46; Dosage is convenient as its long half-life enables a single dose every 2 weeks &#40;1500<span class="elsevierStyleHsp" style=""></span>mg&#41; or 2 doses at an interval of 1 week &#40;1000<span class="elsevierStyleHsp" style=""></span>mg followed by 500<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46; The dose does not need to be adjusted in patients with renal insufficiency&#44; except with a glomerular filtration rate &#60;30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46; The safety profile is acceptable&#44; although medium-to-long-term studies have yet to be done&#46; Dalbavancin was approved by the Spanish Agency of Medicines and Medical Devices in June 2015&#46; Its main indications are infections of the skin and soft tissue&#46; The clinical trials conducted have demonstrated noninferiority of dalbavancin and a comparator &#40;vancomycin<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>linezolid&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Authors Rolston et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> and Jones and Stilwell<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> studied the <span class="elsevierStyleItalic">in vitro</span> activity of dalbavancin against different Gram-positive strains&#44; and showed it to have more potent activity than vancomycin and daptomycin against <span class="elsevierStyleItalic">Bacillus</span> spp&#46;&#44; <span class="elsevierStyleItalic">Corynebacterium</span> ssp&#46;&#44; <span class="elsevierStyleItalic">Micrococcus</span> spp&#46; and several species of streptococci&#44; as well as bactericide activity against methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#44; including those with a minimum inhibitory concentration &#62;1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL of vancomycin&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0035" class="elsevierStylePara elsevierViewall">In summary&#44; we must keep in mind the pathogenic role of <span class="elsevierStyleItalic">Corynebacterium</span> ssp&#46; in certain clinical circumstances and the option of novel antibiotics like dalbavancin that can be just as effective&#44; and reduce the nosocomial infections derived from a prolonged hospital stay&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We describe a case of septic arthritis in a native knee due to <span class="elsevierStyleItalic">Corynebacterium striatum</span>&#44; gram-positive bacilli that are usually commensal organisms of skin and mucosal membranes&#44; but are seldom implicated in native septic arthritis&#46; An 84-year-old man with <span class="elsevierStyleItalic">Corynebacterium striatum</span> septic arthritis of his native left knee and no response to conventional antibiotic therapy&#46; Thus&#44; the patient was allowed to take dalbavancin for compassionate use&#44; with an excellent clinical outcome&#46; This case emphasizes de role of <span class="elsevierStyleItalic">Corynebacterium striatum</span> in native joint infections and highlights the importance of early detection and appropriate treatment in improving the clinical outcome&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describimos un caso de artritis s&#233;ptica de rodilla por <span class="elsevierStyleItalic">Corynebacterium striatum</span>&#44; bacilo Gram positivo colonizador habitual de la flora de la piel y mucosas&#44; que rara vez ha sido implicado en artritis s&#233;pticas de articulaciones nativas&#46; Se trata de un var&#243;n de 84 a&#241;os diagnosticado de artritis s&#233;ptica de rodilla izquierda por <span class="elsevierStyleItalic">Corynebacterium striatum</span> que evoluciona de forma t&#243;rpida con antibioterapia convencional&#44; por lo que se solicita tratamiento compasivo con dalbavancina&#44; con excelente respuesta cl&#237;nica&#46; Este caso resalta el potencial papel pat&#243;geno que las especies del g&#233;nero <span class="elsevierStyleItalic">Corynebacterium</span> pueden tener en artritis s&#233;pticas de articulaciones nativas y subraya la importancia de su detecci&#243;n precoz y tratamiento dirigido para obtener resultados cl&#237;nicos satisfactorios&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Molina Collada J&#44; Rico Nieto A&#44; D&#237;az de Bustamante Ussia M&#44; Balsa Criado A&#46; Artritis s&#233;ptica de rodilla nativa por <span class="elsevierStyleItalic">Corynebacterium striatum</span>&#46; Reumatol Clin&#46; 2018&#59;14&#58;301&#8211;302&#46;</p>"
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