Shiori Kitaya: Department of Infectious Diseases and Laboratory Medicine, Kanazawa University, Kanazawa, 920-8641, Japan. Electronic address: shiorikitaya@staff.kanazawa-u.ac.jp.
Kazuhiro Horiba: Laboratory of Bacterial Genomics, Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, 162-8640, Japan.
Tamon Kabata: Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, 920-8641, Japan.
Takahiro Iyobe: Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, 920-8641, Japan.
Masanori Hashino: Laboratory of Bacterial Genomics, Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, 162-8640, Japan.
Hiroka Yamazaki: Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, 920-8641, Japan.
Yoshinori Takahashi: Department of General Medicine and Infectious Diseases, JA Toyama Koseiren Takaoka Hospital, Takaoka, 933-8555, Japan.
Yoshitaka Zaimoku: Department of Infectious Diseases and Laboratory Medicine, Kanazawa University, Kanazawa, 920-8641, Japan; Department of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 920-8641, Japan.
Megumi Oshima: Department of Infectious Diseases and Laboratory Medicine, Kanazawa University, Kanazawa, 920-8641, Japan; Department of Nephrology and Rheumatology, Kanazawa University, Kanazawa, Ishikawa, 920-8641, Japan.
Hajime Kanamori: Department of Infectious Diseases and Laboratory Medicine, Kanazawa University, Kanazawa, 920-8641, Japan.
Pyogenic arthritis with gas gangrene triggered by intra-articular steroid injections can occasionally result in fatal complications. Clostridium perfringens is typically the causative pathogen, with infections caused by Fusobacterium species being relatively rare. Fusobacterium species are known to cause pyogenic infections, but due to their extreme sensitivity to oxygen, they can be difficult to detect with traditional culture methods. Recently, metagenomic next-generation sequencing (mNGS) has gained attention as an alternative diagnostic tool to traditional culture, enabling rapid identification of causative pathogens in infectious diseases, including Pyogenic arthritis. Its use is illustrated in the following case report, which demonstrates the diagnostic utility of mNGS in Pyogenic arthritis with gas gangrene triggered by an intra-articular steroid injection. Using mNGS as a complement to conventional culture testing allows for a more precise narrowing-down of causative pathogens, enabling targeted therapy and improving patient outcomes. This approach may also help reduce the use of broad-spectrum antibiotics and prevent the emergence of antibiotic-resistant bacteria.
