Pseudoseptic arthritis resulting in joint destruction

Abstract

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.

Pseudoseptic Arthritis: An Initial Presentation of Underlying Psoriatic Arthritis

“…Pseudoseptic arthritis is a recurrent condition and it can lead to joint destruction [ 9 ]. Furthermore, underlying psoriatic arthritis in this patient might aggravate the joint condition and result in long-term morbidity.…”

Pseudoseptic Arthritis in a Patient With Psoriasis

“…These patients had negative blood cultures, no identifiable port of entry, or any other concomitant infection. Since then, there have been multiple other cases describing a similar pattern of pseudoseptic arthritis [ 3 , 4 ]. It is described primarily on rheumatoid arthritis (RA) and has been reported in other chronic diseases like Bechet's, gout, pseudogout, relapsing polychondritis, prosthetic joints, following immunosuppressive therapy, and intraarticular injections [ 3 ].…”

“…He was treated with unspecified intravenous antibiotics before making a PSA diagnosis. However, that patient required total joint replacement due to destruction [ 4 ].…”

“…Dr Mandell reveals that about 33% of patients had a full recovery, and 25% died [ 6 ]. Unfortunately, the statements made on that Call et al paper in 1985 have now been used in recent articles, leading to discontinuation of antibiotics once septic arthritis is ruled out and instead of treating with anti-inflammatory therapies [ 3 , 4 ].…”