Rheumatic disease presenting as septic arthritis: a report of 10 cases

Rheumatol Int (2013) 33:21532158 DOI 10.1007/s00296-012-2364-x

SHORT COMMUNICATION

Rheumatic disease presenting as septic arthritis: a report of 10 cases

Julie Eberst-Ledoux Anne Tournadre

Claudie Makarawiez Catherine Le Quang

Martin Soubrier Jean-Jacques Dubost

Received: 27 May 2011 / Accepted: 11 March 2012 / Published online: 25 March 2012 Springer-Verlag 2012

Abstract To determine the forms and characteristics of rheumatic diseases whose initial presentation mimics septic arthritis. Retrospective study of 398 patients hospitalized between 1979 and 2005 for arthritis diagnosed and treated as septic. In 10 cases, initial presentation of a rheumatic disease was highly suggestive of septic arthritis, and the patient was treated as such. Three had rheumatoid arthritis, 3 spondyloarthropathies, 2 unclassied rheumatic diseases, 1 Wegener granulomatosis and 1 cytosteatonecrosis. Mean time to diagnosis of rheumatic arthritis was 6 months. There were 7 males and 3 females aged from 15 to 77 years. Six had fever, and 3 had leucocytosis. Average ESR was 68 mm/1 h, and C-reactive protein was above 100 mg/l in 6 patients. Five patients had radiological signs suggestive of septic arthritis. Joint uid count was above 100,000 WBCs/mm3 in 2/5. Synovial biopsy suggested septic arthritis in 5 out of 6. These cases of pseudoseptic arthritis were indistinguishable from true septic arthritis. Follow-up is required in septic arthritis with negative culture ndings to exclude rheumatic disease.

Keywords Pseudoseptic arthritis Septic arthritis

Infectious arthritis Rheumatoid arthritis

Septic arthritis is dened as evidence of a living microorganism in the joint. However, in about 20 % of cases, bacteriological investigations are negative [1] and other diagnoses such as microcrystalline, viral or rheumatic arthritis are sought for. Pseudoseptic arthritis episodes may complicate the course of various rheumatic diseases [27]. Diagnosis is very hard when pseudoseptic arthritis is the rst manifestation of the rheumatic disease.

We reviewed the les of 398 patients hospitalized between 1979 and 2005 for septic arthritis that was treated by antibiotics for at least 6 weeks. In 74 cases, neither joint specimens nor blood cultures revealed any organisms. Ten of these patients (13.5 %) developed a form of rheumatic disease (Table 1).

Case 1 A 58-year-old man was admitted in October 1988 for arthritis in the knees that had progressed over the past 6 months. ESR was 89 mm/h, and C-reactive protein...