BACTERIAL ARTHRITIS THAT occurred in four patients during neurosurgica
l convalescence is reported. Three patients had a cerebral aneurysm cl
ipped after a subarachnoid hemorrhage, and one had herpes simplex ence
phalitis with a possible temporal lobe hemorrhage. All four patients h
ad been treated with steroids. A total of six joints were infected, tw
o patients with an infection in one joint each, and two with a metachr
onous infection in two joints. The interval between the onset of local
symptoms and the definitive diagnosis ranged from 0 to 44 days. A del
ay in diagnosis severely compromises joint function, and all four of t
hese patients were left with an associated significant musculoskeletal
disability. Bacterial arthritis is well recognized in the immunocompr
omised patient, but, to our knowledge, has not been described in this
particular clinical setting. A patient with a sustained pyrexia of unk
nown origin in the neurosurgical convalescent period should be suspect
ed of having an occult musculoskeletal infection. An isotope bone scan
to facilitate early diagnosis is recommended, and this, combined with
specific aggressive therapy, should preserve joint function.