Jump to the content zone at the center

Lethal Septic Arthritis in Guise of Gout

Cai Ming-han, director of the Division of Allergy, Immunology and Rheumatology in Ren’ai Branch of Taipei City Hospital, says that septic arthritis, also known as pyogenic arthritis, often occurs in knee joints. The risk factors of the patients comprise diabetes, liver cirrhosis, long-term use of immunosuppressor, and so on. The lack of immediate and effective treatment may result in permanent disability of the infected joint, and even the death of a third of patients.
Mr. Li, 76 years old, has suffered from diabetes and prostate enlargement. He had a sudden high fever about 1 month ago and the severe swelling and pain in the right knee made him unable to walk, so he was immediately sent to a hospital. His temperature taken in the emergency room was as high as 39ºC. There was obvious swelling and heat pain in the right knee joint so that even touching the affected part slightly gave him a sharp pain. The blood test showed an increase in leukocytes and acute inflammation indexes. He was preliminarily diagnosed with acute gout arthritis. As the patient had a fever and severe pain in the joint, he was hospitalized for further examination and treatment.
After hospitalization, due to the severe swelling of his right knee, joint fluid was extracted immediately to alleviate the symptoms and sent for examination. The joint fluid test found as high as 155,000 white blood cells (the number of white blood cells in normal joint fluid is about 2,000), which meant bacterial infection in the joint fluid. Therefore, it was judged that the patient did not suffer from gout arthritis but rather the more severe septic arthritis instead, which was complicated by cellulitis in the right calf. He was administered intravenous antibiotics and ice compress. Colibacillosis was cultured from the joint fluid several days later, which confirmed that the septic arthritis was caused by bacterial infection. After three weeks’ continuous antibiotic therapy and several joint fluid extractions, he was discharged from the hospital and is currently being followed up regularly in the outpatient department.
Dr. Cai especially reminds the public that septic arthritis is often mistaken for gout attack and thus is ignored. People with sudden joint pain and even fever should go to a hospital immediately, to avoid irremediable tragedy.
※Reference citation: Lin WT et al. Clinical manifestations and bacteriological features of culture-proven Gram-negative bacterial arthritis. J Microbiol Immunol Infect 2015 Sep. 18. Pii: S1684-1182 (15) 00850-6.