Pseudoseptic arthritis is an increasingly recognised entity. It is an inflammatory arthritis that mimics septic arthritis; however, Gram stain and cultures are persistently negative. It is a diagnosis of exclusion. We present the first case, to date, in which pseudoseptic arthritis led to such severe joint degeneration that joint replacement surgery was required. A 54-year-old truck driver with rheumatoid arthritis, on immunosuppressive therapy, presented with acute onset severe left hip pain. He was given a clinical diagnosis of septic arthritis and treated with two prolonged courses of antibiotics despite persistently negative synovial fluid cultures. He experienced progressive joint destruction necessitating a two-stage total hip replacement. A retrospective diagnosis of pseudoseptic arthritis was made. This case demonstrates the difficulties inherent in differentiating between septic and pseudoseptic arthritis. This case also highlights the importance of accurate diagnosis and treatment for pseudoseptic arthritis to avoid accelerated joint destruction.

Background Presence of gas in the subcutaneous tissue in a limb is always worrisome. Majority of the cases occur due to infection by gas-forming organism and less commonly due to non-infectious causes. Case report We report a case of 52-year-old male who presented with an acute onset rapidly spreading swelling of the hand and forearm following a minor splinter injury. There was no distal neurovascular compromise. He underwent an emergency fasciotomy. Discussion Here we discuss about non-infective subcutaneous emphysema of the limbs and the need to be aware of this potentially harmless condition. We believe that even in minor injuries resulting in extensive non-infective emphysema, a prophylactic decompression even in the absence of neurovascular compromise would be a prudent action, which does not necessarily lead to increased morbidity.

Introduction Adult long-bone osteomyelitis is relatively uncommon in the developed countries. Ruptured sigmoid diverticulitis can seldom present as an extraperitoneal manifestations in the gluteal area, around the hips, or in the proximal thigh. These extraperitoneal manifestations can present a diagnostic challenge and need a high index of suspicion. Case report We present a case of a 67-year-old male with osteomyelitis of the proximal femur following a ruptured diverticular disease of the sigmoid colon. Discussion The diagnosis was delayed resulting in advanced destruction of the hip necessitating a two-stage hip replacement. We hereby discuss the unusual extraperitoneal presentations of sigmoid diverticulitis and the need to identify them early. Keywords Femoral osteomyelitis . Sigmoid diverticulitis Case reportA 67-year-old male was admitted into the hospital with a history of lower back pain with radiation to the back of the left thigh. Clinical diagnosis of acute discitis/disc prolapse was made. An urgent MRI was performed which revealed no evidence of discitis or significant disc prolapse. As he continued to have intermittent temperature spikes and persistently high CRP, an abdominal and pelvic CAT scan was performed. The scan revealed a severe sigmoid diverticular disease and a small psoas collection. The psoas collection was aspirated under ultrasound guidance followed by a 3-week course of oral antibiotics. Repeat CAT scan after 6 weeks showed improved diverticular disease and no new collection. The areas of the hips and the proximal thigh/ femur were not specifically examined or commented upon in both the CAT scans.He was discharged from the clinic with a plan for followup by his general practitioner. He presented around 6 months later with progressively worsening left-groin pain of few months duration. He had been treated by his practitioner with strong analgesics including morphine patch. Repeat blood tests at this stage revealed a high CRP and ESR. X-rays of the pelvis revealed destruction of the proximal femur with loss of joint space (Fig. 1). An urgent MRI scan of the pelvis revealed proximal femoral osteomyelitis with advanced destruction of the femoral head (Fig. 2). Fig. 1 X-ray showing destruction of left femoral head