Ann Rehabil Med.  2014 Aug;38(4):563-567. 10.5535/arm.2014.38.4.563.

Brachial Plexus Neuritis Associated With Streptococcus agalactiae Infection: A Case Report

• Seo YJ
• Lee YJ
• Kim JS
• Lim SH
• Hong BY

• KMID: 2165741
• DOI: http://doi.org/10.5535/arm.2014.38.4.563

Abstract

Brachial plexus neuritis is reportedly caused by various factors; however, it has not been described in association with Streptococcus agalactiae. This is a case report of a patient diagnosed with brachial plexus neuritis associated with pyogenic arthritis of the shoulder. A 57-year-old man visited the hospital complaining of sudden weakness and painful swelling of the left arm. The diagnosis was pyogenic arthritis of the left shoulder, and the patient was treated with open irrigation and debridement accompanied by intravenous antibiotic therapy. S. agalactiae was isolated from a wound culture, and an electrodiagnostic study showed brachial plexopathy involving the left upper and middle trunk. Nine weeks after onset, muscle strength improved in most of the affected muscles, and an electrodiagnostic study showed signs of reinnervation. In conclusion, S. agalactiae infection can lead to various complications including brachial plexus neuritis.

Keyword

Brachial plexus neuritis; Streptococcus agalactiae; Brachial plexus neuropathies

MeSH Terms

Arm
Arthritis
Brachial Plexus Neuritis*
Brachial Plexus Neuropathies
Debridement
Diagnosis
Humans
Middle Aged
Muscle Strength
Muscles
Shoulder
Streptococcus agalactiae*
Wounds and Injuries

Figure

• 

  Fig. 1 Magnetic resonance imaging (T1) shows myositis of the deltoid muscle (arrowhead), subdeltoid abscess formation (asterisk), and septic arthritis in the left shoulder joint (arrow).

• 

  Fig. 2 Photograph shows atrophy of the left supraspinatus, infraspinatus, and deltoid muscles.

Reference

1. van Alfen N, van der Werf SP, van Engelen BG. Long-term pain, fatigue, and impairment in neuralgic amyotrophy. Arch Phys Med Rehabil. 2009; 90:435–439. PMID: 19254608.

2. van Alfen N, van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain. 2006; 129(Pt 2):438–450. PMID: 16371410.

3. Nolla JM, Gomez-Vaquero C, Corbella X, Ordonez S, Garcia-Gomez C, Perez A, et al. Group B streptococcus (Streptococcus agalactiae) pyogenic arthritis in nonpregnant adults. Medicine (Baltimore). 2003; 82:119–128. PMID: 12640188.

4. Farley MM, Harvey RC, Stull T, Smith JD, Schuchat A, Wenger JD, et al. A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults. N Engl J Med. 1993; 328:1807–1811. PMID: 8502269.

5. Verma R, Sharma P, Khurana N, Sharma LN. Neuralgic amyotrophy associated with dengue fever: case series of three patients. J Postgrad Med. 2011; 57:329–331. PMID: 22120863.

6. McCarty EC, Tsairis P, Warren RF. Brachial neuritis. Clin Orthop Relat Res. 1999; (368):37–43. PMID: 10613151.

7. Stek CJ, van Eijk JJ, Jacobs BC, Enting RH, Sprenger HG, van Alfen N, et al. Neuralgic amyotrophy associated with Bartonella henselae infection. J Neurol Neurosurg Psychiatry. 2011; 82:707–708. PMID: 20710009.

8. Dumitru D, Zwarts MJ. Brachial plexopathies and proximal mononeuropathies. In : Dumitru D, Amato AA, Zwarts MJ, editors. Electrodiagnostic medicine. 2nd ed. Philadelphia: Hanley & Belfus;2002. p. 816–817.

9. Gonzalez-Alegre P, Recober A, Kelkar P. Idiopathic brachial neuritis. Iowa Orthop J. 2002; 22:81–85. PMID: 12180618.

10. Pica EC, Verma KK. Bilateral brachial plexopathy as an initial presentation in a newly-diagnosed, uncontrolled case of diabetes mellitus. Singapore Med J. 2008; 49:e29–e32. PMID: 18301821.