Hypogammaglobulinemic Patient with Polyarthritis Mimicking Rheumatoid Arthritis Finally Diagnosed as Septic Arthritis Caused by Mycoplasma hominis

Abstract

Hypogammaglobulinemia is a reduction or absence of immunoglobulin, which may be congenital or associated with immunosuppressive therapy. In addition to infectious diseases, autoimmune diseases have also been reported in patients with hypogammaglobulinemia. A 26-year-old man with hypogammaglobulinemia had multiple joint pain and swelling with erosive changes in the proximal interphalangeal joint of the right middle finger on X-ray film, mimicking rheumatoid arthritis (RA). As polyarthritis remained after immunoglobulin replacement therapy and there was no finding indicating any infection at that time, a diagnosis of RA was made. Prednisolone and etanercept were started. However, his polyarthritis did not improve and he developed meningitis and massive brain ischemia. Finally, a diagnosis of disseminated Mycoplasma hominis infection was made. The differential diagnosis of polyarthritis in patients with hypogammaglobulinemia should strictly exclude Mycoplasma infection by culture with special media or longer anaerobic culture, and molecular methods for mycoplasma.

Host Cell Responses to Persistent Mycoplasmas - Different Stages in Infection of HeLa Cells with Mycoplasma hominis

“…In 2009 Kang et al showed that downregulation of HSP70 protects rheumatoid arthritis fibroblast-like synoviocytes from NO-induced apoptosis [31]. Interestingly, M. hominis is known to be associated with arthritis [32] with symptoms similar to rheumatoid arthritis [33] known to be the result of an autoantibody response.…”

Fatal nosocomial meningitis caused by Mycoplasma hominis in an adult patient: case report and review of the literature

“…To date, only 16 cases of central nervous system (CNS) infection caused by M. hominis have been described since 1950 (Table 1). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] A new case of meningitis caused by this bacterium in an adult, following a neurosurgical procedure, is reported here.…”

PostoperativeMycoplasma hominisbrain abscess: keep it in mind!

“…The recent cases describe isolation of M. hominis a number of days following hospital admission with patients having contributing factors such as head trauma, neurosurgery, genitourinary or delivery manipulations 1–16. A separate group at increased risk of extra-genital M. hominis infections are those with congenital and acquired immunodeficiency due to impaired cell-mediated and antibody-mediated immunity; these include immune-suppressive therapy post organ transplantation, collagen vascular disease and hypogammaglobulinaemia,16 18 19…”

“…Extra genital sites of infection include vascular site infections, surgical wounds, joint infection and respiratory tract infections,16 18 19 As described, M. hominis has also emerged as an infrequent but important cause of postoperative central nervous system infections. M. hominis asymptomatically colonises the urogenital tract (15%) and more rarely the respiratory tract mucosa of healthy individuals 1–16.…”

“…This has led to the recognition of M. pneumoniae , M. salivarium , M. fermantans and M. hominis as pathogens when isolated outside their commensal locations 1 3–4 10–14 16 21 22. MALDI-TOF mass spectrometry can also be used to identify M. hominis from culture,2 as long as the library includes the M. hominis spectrum.…”