A rare cause of oligoarthritis with septic presentation

Abstract

A 33-year-old man presented with new-onset, asymmetric, migratory oligoarthritis in the setting of several weeks of nausea and vomiting, diarrhoea, fevers and dysuria. He was initially treated in the inpatient setting with broad-spectrum antibiotics due to concern for an evolving sepsis presentation. Arthrocentesis of a large right knee effusion revealed inflammatory synovial fluid without findings suggestive of septic arthritis. Human leucocyte antigen B27 was positive and, taken together with the antecedent history of gastroenteritis, dysuria and inflammatory oligoarthritis, the clinical diagnosis was most consistent with reactive arthritis. Antibiotics were discontinued. His treatment course proved refractory to non-steroidal anti-inflammatory drugs and intra-articular and systemic glucocorticoid therapy with concurrent use of sulfasalazine and ultimately necessitated treatment with a tumour necrosis factor alpha inhibitor.

Group B Streptococcus Bacteremia Mimicking Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome

“…In addition, antibiotic treatment (with fluoroquinolone) was ineffective, and acute oligoarthritis involving the sternoclavicular and sacroiliac joints was noted. In a similar case report about a patient with oligoarthritis, initial management with broad-spectrum antibiotics worsened the patient’s condition; eventually, the patient was diagnosed with reactive arthritis [ 7 ]. Therefore, we initially considered that infectious osteitis and bone tumoral conditions were unlikely.…”

Approaching Reactive Arthritis Associated With Poor Prognostic Factors: A Case Report and Literature Review

“…Interestingly, case number 1 and case number 10 (Table 4 ) initiated DMARDs and TNF inhibitors (TNFI) even before the use of oral steroids [ 15 , 16 ]. Case numbers 1 and 2 (Table 4 ) have demonstrated the use of adalimumab [ 9 , 15 ]. It is notable to mention that five or greater prognostic factors were identified in both cases in which adalimumab was used.…”

“…We analyzed 14 case reports and four large-scale studies that are pertinent for our discussion. The case reports and the large studies are displayed in Table 4 [3][4][5][6][7][8][9][10][11][12][13][14][15][16] and Table 5 [17][18][19][20], respectively. We risk-stratified the case reports by poor prognostic factors and analyzed the treatment options in the order they were used in each case study.…”

“…Five case reports documented the use of oral steroids as the second choice of therapy after non-relief with NSAIDs [8][9][10][11]14,16]. Case number 8 ( Table 4) initiated oral steroids as a first line therapy, followed by DMARD therapy for additional symptom control [11].…”

“…Case number 10 chose oral steroid after trial of NSAID and DMARD therapy for symptomatic management [16]. Out of these five cases which required oral steroids after failure with NSAIDs, one case presented with five poor prognostic factors, two cases with four poor prognostic factors, one with three poor prognostic factors and one with two poor prognostic factors [8][9][10]14]. They uniformly required the use of DMARDs.…”