Clinical and biological characteristics of Ureaplasma urealyticum induced polyarthritis in a patient with common variable hypogammaglobulinaemia

Article Abstract:

Hypogammaglobulinemia, or low blood levels of protective gamma globulins (antibodies), has sometimes been associated with infection-related arthritis caused by a member of the mycoplasma family of bacteria. Previous reports of case studies have indicated that patients usually recovered when antibiotics and replacement gamma globulin were given, although one patient developed recurrent arthritis and antibiotic resistance. A case is reported of a 38-year-old man who developed recurrent infections from the age of 23. Hypogammaglobulinemia was diagnosed at age 28. Monthly treatment with gamma globulin decreased the frequency of respiratory tract infections. The frequency of gamma globulin treatments was reduced at age 34, but 6 months later the patient developed polyarthritis, or inflammation involving many joints. The hands, wrists, elbows, shoulders, feet, ankles, knees, and hips were affected, and tenosynovitis (inflamed tendons) also developed. Sampling of synovial (joint) fluid showed very low levels of glucose and white blood cells, but no bacteria could be found. Treatment with gamma globulin and indomethacin, an anti-inflammatory agent, failed to improve the arthritic condition. The wrist joint and tendons were treated surgically, and joint destruction similar to rheumatoid arthritis was found. The joint fluid was cultured for bacteria, and Ureaplasma urealyticum (a member of the mycoplasma family) was isolated. Treatment with tetracycline improved the synovitis (inflammation of the joint lining), but it flared again. Several other antibiotics also provided initial improvement, but symptoms continued to recur. Joint destruction continued, and the bacteria was still present in synovial fluids. Soft tissue abscesses formed over the surfaces of limbs. Approximately one year after the start of polyarthritis, the patient was treated with rosaramicin because of medical deterioration, and this was continued, although the bacteria isolated from some joints became resistant to the drug. The antibiotic was stopped three years after it was first given, and no severe complications have developed. DNA analysis and electron microscopy were used to confirm the presence of Ureaplasma in many joints during the patient's illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mycoplasma infections, Ureaplasma urealyticum, Agammaglobulinemia

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An unusual presentation of gonococcal arthritis in an HIV positive patient

Article Abstract:

Gonococcal arthritis (caused by gonorrhea bacteria) is a common and recognizable disorder. It frequently affects many joints, especially the knees, hands and fingers, ankles, and elbows. The hip joint is rarely involved, and effects on the sternoclavicular joint (the attachment between the collarbone and sternum, or breastbone) are unknown. A case is described of a 27-year-old man who tested positive for HIV (human immunodeficiency virus, the cause of AIDS) and developed gonococcal arthritis of the hip and sternoclavicular joint. The patient had a 10-day history of fever and joint pains; he initially experienced right ankle pain and stiffness and pain in the right hand, which had resolved. Soon after, he developed increasing pain and loss of motion in the right hip, severe enough that he was confined to bed. Pain also developed in the front left shoulder girdle. He had anal intercourse 10 days before the onset of the first symptoms. On examination, the right hip was warm and could not be moved actively (by the patient) or passively (by an examiner). The left sternoclavicular joint was also warm and tender, and motion produced discomfort. Infectious arthritis was the presumed diagnosis, and antibiotics were started; samples of hip joint fluid grew gonorrhea bacteria in the lab. Within two days after the start of treatment, the fever resolved, joint discomfort improved, and hip motion increased. After seven days of antibiotic treatment, the patient was pain-free and had nearly normal hip motion. HIV infections have been associated with a number of rheumatological disorders, but disseminated gonococcal infections have been surprisingly rare. Physicians should suspect the presence of gonococcal arthritis, even if atypical joints are affected. Diagnosis of gonococcal arthritis may precede diagnosis of HIV, and HIV testing should be done in individuals with infectious arthritis due to gonococcal bacteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexually transmitted diseases, HIV infection, HIV infections, Gonorrhea

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Sporotrichal arthritis

Article Abstract:

Sporotrichosis (also called Schenck's disease) is a disease that is caused by the fungus Sporothrix schenckii. This fungus can be found in the soil and on plants, especially thorny bushes, and can enter the human body through the skin and lungs. Sporotrichosis affects the skin and lymph tissues, and can cause pneumonia or osteomyelitis (inflammation of the bone or bone marrow). Arthritis is a rare complication of this disease; it is estimated to occur in fewer than 1 percent of the patients with sporotrichosis. When arthritis does occur, it affects mainly the knees, hands and wrists, and the cause is difficult to diagnose. This article describes the case of a 49-year-old man who developed arthritis in several different joints after becoming infected with Sporothrix schenckii. His first symptoms included swelling in the right knee and the left ankle, elbow and wrist. Laboratory tests showed inflammation in the joints, and there was no sign of bacterial infection. The patient was diagnosed as having joint inflammation caused by gout or rheumatoid arthritis. His symptoms became worse over the next 10 months. A sample of fluid was taken from the right knee and was tested for the presence of fungi. The sample was found to contain Sporothrix schenckii, and the patient was diagnosed as having sporotrichosis. The patient was treated with amphotericin B, and the membranes lining the joints were removed from the right knee and left ankle. This case report serves to point out the difficulties in recognizing and diagnosing arthritis caused by infection with Sporothrix schenckii. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sporotrichosis

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