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This case report describes an elderly patient with diabetes mellitus who presented with bilateral shoulder pain and raised inflammatory markers without fever, overlying erythema, joint swelling or joint warmth. The clinical course, differential diagnosis, management with bilateral shoulder washout and antibiotics and efforts to identify a central source of infection are detailed in this report. This case highlights the need for a high index of suspicion for septic arthritis when patients present with joint pain lacking common clinical signs of septic arthritis. Early joint aspiration, antibiotic therapy and surgical management are critical to optimising outcomes, even in the absence of classic clinical signs.<\/jats:p>","DOI":"10.1136\/bcr-2025-271810","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:15:22Z","timestamp":1790100922000},"page":"e271810","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Culture-positive left shoulder septic arthritis with suspected contralateral involvement secondary to\n                    <i>Staphylococcus aureus<\/i>\n                    bacteraemia"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1371-9625","authenticated-orcid":false,"given":"Adeolu Toluwani","family":"Adenipekun","sequence":"first","affiliation":[{"name":"ESNEFT, NHS, Ipswich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Burton","sequence":"additional","affiliation":[{"name":"Acute Medicine, NHS, Ipswich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211151526000_19.9.e271810.1","doi-asserted-by":"crossref","unstructured":"Calder P . 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