Listerienarthritis bei chronischer Polyarthritis unter Low-dose-Prednisolon- und Methotrexat-Therapie

Abstract

We report about a patient with polyarticular rheumatoid arthritis taking methotrexat and 5 mg prednisolone who developed in the course of a RA flare a septic arthritis in the right shoulder. Listeria monocytogenes could be identified as the causative bacteria. Clinically, the Listeria-induced septic arthritis could not be differentiated from rheumatoid arthritis; fever was not present. The synovial analysis showed a granulocytic effusion with 19,000 cells/ml; there was no microbiological growth within the first 24 hours. Only the low glucose level indicated a possible septic arthritis. After 48 hours, gram-positive bacterial growth was evident and Listeria monocytogenes could be isolated after 72 hours. Therapy was initiated by antibiotic treatment and arthrotomy with synovectomy followed by extensive irrigation which proved effective in bacterial elimination but joint destruction resulted. During the whole course, Listeria antibodies were negative and proved to be too insensitive. The incidence of Listeria-induced arthritis is very low; a review of the literature revealed only 24 reported cases. It occurs primarily in patients with rheumatic diseases under immunosuppression and in prosthetic joints. The diagnosis is based on cultural detection. It is important to cultivate synovial effusions for longer than 24 hours in order to identify Listeria. This is of relevance since Listeria serology is not sensitive.

Corticosteroid Therapy in an Alphaviral Arthritis

“…8 -12 However, these reports are largely restricted to bacterial arthritides and often involve immunosuppressive steroid treatment before the generation of protective immunity. 8,9,11 Steroid treatment in the 6 patients with RRVD was initiated after generation of anti-RRV antibodies, as demonstrated by serodiagnosis, al- though before generation of RRV-specific IgG antibodies in patient nos. 1 and 6 ( Table 1).…”

Listeria monocytogenes septic arthritis in a patient treated with mycophenolate mofetil for polyarteritis nodosa: a case report and review of the literature

“…The knee was the most frequently affected joint, and two cases involved more than one joint. 3,4,5 Four patients were receiving methotrexate as immunosuppressive therapy, 2,4,6,7 and two patients were receiving etanercept. 2 Outcomes were good for all seven of the seven patients treated successfully.…”

“…Two patients needed surgery to cure the infection. 1,3 Mycophenolate mofetil is a selective and reversible inhibitor of inosine monophosphate dehydrogenase that inhibits the de novo pathway of guanosine nucleotide synthesis, necessary for T and B lymphocyte proliferation. Mycophenolic acid also has a potent cytostatic effect on lymphocytes, inhibiting the response of lymphocytes to mitogenic and allospecific stimulation.…”

Arthritis verursacht durch Listeria monocytogenes

“…Listerienarthritiden betreffen vor allem Knie-und Hüftgelenk, deutlich seltener Schulter- [27,30] und Ellenbogengelenk [21]. Meist ist nur ein Gelenk infiziert, es gibt aber Berichte über Patienten mit 2 [10,26] bzw.…”