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Objective. We report a hypogammaglobulinemic patient with a destructive oligoarticular arthritis, whose synovial fluid cultures were repeatedly sterile.Methods and Results. We identified a Ureaplasma ureulyticurn infection in his affected joints, using a polymerase chain reaction (PCR) assay. Conclusion. The PCR technique promises to be extremely valuable in the rapid and specific diagnosis of infectious arthritis.Ureaplasma urealyticum, a mycoplasma organism which commonly colonizes the human urogenital tract, has been described as the cause of septic arthritis in several patients with hypogammaglobulinemia (14). However, this organism is difficult to isolate in culture and requires special culture media. We report a hypogammaglobulinemic patient with a destructive oligoarticular arthritis, in whom microbiologic cultures were sterile, but in whom a polymerase chain reaction (PCR) assay revealed the presence of U urealyticurn.Analysis of T cell receptor transcripts present in the synovium indicated a polyclonal population of T cells responding to this infection. CASE REPORTThe patient, a 27-year-old black man with the a-thalassemia trait and dysgammaglobulinemia, was admitted to the Hospital of the University of Pennsylvania for evaluation of persistent pain and swelling in the wrists and right ankle. He had. been healthy until the age of 14, when he began to have recurrent bouts of pneumonia. Serum imrnunoglobulin measurement showed an IgM level of 9.25 gm/ liter (normal 0.7-2.10) and undetectable IgG and IgA. Immunoglobulin deficiency with increased IgM was diagnosed, and the patient was treated with intermittent intravenous immunoglobulin therapy.At age 21 he began to experience pain and swelling of the right ankle and right shoulder. Shoulder roentgenograms revealed a destructive osteolysis of subchondral bone in the right humeral head. Subsequently, the right shoulder was surgically fused. Cultures for bacteria, rnycobacteria, and fungi, from material obtained at surgery, were sterile, and results of assays for rheumatoid factor were negative. Three months later, a surgical fusion of the left ankle was at-