"My foot hurts": a flare of rheumatoid arthritis?
A 56-year-old man with a history of rheumatoid arthritis presented with a 2-day history of worsening pain in his left foot. Treatment with high-dose steroids was of no benefit, hence a diagnosis of septic arthritis was considered. However, the patient's condition deteriorated despite empirical antibiotic therapy. Following persistent investigation, the cause was identified as a fastidious Legionella longbeachae infection, and appropriate antibiotic therapy led to complete resolution of the sepsis. This emphasises the importance of considering infections with atypical organisms in patients on immunosuppressive therapy.
Dugar
Manish
M
Flinders Medical Centre, Adelaide, SA, Australia. manish.dugar@health.sa.gov.au
Rankin
Wayne A
WA
Rowe
Emily
E
Smith
Malcolm D
MD
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D001372:Aza Compounds / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones; D006801:Humans; D044128:Legionella longbeachae / Q000302:isolation & purification*; D007876:Legionellosis / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D009503:Neutropenia / Q000209:etiology; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D011804:Quinolines / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use
D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D013256:Steroids; D017963:Azithromycin; D000077266:Moxifloxacin