Human oral flora causing subcutaneous soft tissue abscess and septic arthropathy after testosterone injections

Testosterone injections are used to treat hypogonadism but can be associated with the complication of infection and soft tissue abscess development. Clinical presentation can vary and can be nonspecific. Diagnostic work-up includes imaging and laboratory studies. Treatment includes incision and drainage, as well as antibiotic treatment based on culture findings. However, some cases may require surgical intervention for proper treatment. A 51-year-old male presented to the emergency department (ED) multiple times due to right thigh pain following testosterone injections. Imaging findings showed soft tissue fluid collection. Aspiration and incision and drainage were performed at different visits, and cultures showed Eikenella corrodens (E. corrodens ) and Streptococcus anginosus ( S. anginosus ) . At those visits, the patient was treated with and discharged on antibiotics . After that, the patient developed right posterior knee pain, and aspiration of the knee joint showed high white blood cell count in the aspirate, with S. anginosus, Schaalia odontolytica , and yeast found on analysis. The patient was then hospitalized and underwent debridement and irrigation of the knee and thigh. The patient was discharged on antibiotics and outpatient follow up showed appropriate recovery with no complications. Soft tissue abscesses can result in vague symptoms and nonspecific laboratory findings. A high index of suspicion is necessary for patients with a history of testosterone injections to provide proper treatment. Delays in treatment can result in the spread of infection and the development of complications, such as septic arthropathy in this case.