Streptococcus pneumoniae septic arthritis is an uncommon infection. The classic clinical picture is that of concomitant pulmonary and/or meningeal and joint infections in the presence of predisposing local and systemic factors. Initial laboratory tests are usually inconclusive, and joint aspiration is required for a definitive diagnosis. Treatment options include antibiotic therapy (usually with penicillin) combined with closed or open joint drainage. Increasing reports of infections involving penicillin-resistant strains are a concern. The prognosis is usually favourable, but early recognition and aggressive management are essential to reduce the likelihood of significant joint injury.