Glenohumeral joint septic arthritis in a native joint is uncommon but can be debilitating if not treated early. Septic arthritis does not always present with the typical clinical findings, especially in immunocompromised patients. We report a rare case of glenohumeral septic arthritis from Streptococcus mitis infection in a diabetic woman that was initially missed on first presentation in the emergency department (ED). The exact cause of infection in this case remains unclear but is likely due to poor dentition and possible transient bacteremia in the setting of large rotator cuff tear in an immunocompromised patient (diabetes). The patient had a good outcome after returning to the ED three days later and undergoing shoulder arthrotomy, irrigation, and initiation of intravenous antibiotics. It is important to keep a high clinical suspicion for septic arthritis in immunocompromised patients with atraumatic shoulder pain.

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