Page Felicity, Chadwick Sarah, Banerjee Brian
Department of Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK.
North West Deanery, Manchester, UK.
BMJ Case Rep. 2015 May 6;2015:bcr2014208269. doi: 10.1136/bcr-2014-208269.
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.
假性化脓性关节炎是一种越来越被认可的病症。它是一种模仿化脓性关节炎的炎症性关节炎；然而，革兰氏染色和培养结果持续为阴性。它是一种排除性诊断。我们报告了首例迄今为止因假性化脓性关节炎导致严重关节退变而需要进行关节置换手术的病例。一名54岁患有类风湿性关节炎且正在接受免疫抑制治疗的卡车司机，出现急性发作的严重左髋部疼痛。尽管滑膜液培养结果持续为阴性，但他被临床诊断为化脓性关节炎并接受了两个疗程的长期抗生素治疗。他经历了渐进性的关节破坏，需要进行两阶段全髋关节置换。最终做出了假性化脓性关节炎的回顾性诊断。该病例显示了区分化脓性关节炎和假性化脓性关节炎所固有的困难。此病例还突出了对假性化脓性关节炎进行准确诊断和治疗以避免关节加速破坏的重要性。
