title: Hypogammaglobulinemic patient with polyarthritis mimicking rheumatoid arthritis finally diagnosed as septic arthritis caused by Mycoplasma hominis.
abstract: Hypogammaglobulinemia is a reduction or absence of immunoglobulin, which may be congenital or associated with immunosuppressive therapy. In addition to infectious diseases, autoimmune diseases have also been reported in patients with hypogammaglobulinemia. A 26-year-old man with hypogammaglobulinemia had multiple joint pain and swelling with erosive changes in the proximal interphalangeal joint of the right middle finger on X-ray film, mimicking rheumatoid arthritis (RA). As polyarthritis remained after immunoglobulin replacement therapy and there was no finding indicating any infection at that time, a diagnosis of RA was made. Prednisolone and etanercept were started. However, his polyarthritis did not improve and he developed meningitis and massive brain ischemia. Finally, a diagnosis of disseminated Mycoplasma hominis infection was made. The differential diagnosis of polyarthritis in patients with hypogammaglobulinemia should strictly exclude Mycoplasma infection by culture with special media or longer anaerobic culture, and molecular methods for mycoplasma.
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan. hiroe-212@umin.ac.jp
authors.forename: Hiroe
authors.initials: H
authors.lastname: Sato
authors.forename: Noriaki
authors.initials: N
authors.lastname: Iino
authors.forename: Riuko
authors.initials: R
authors.lastname: Ohashi
authors.forename: Takako
authors.initials: T
authors.lastname: Saeki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ito
authors.forename: Maki
authors.initials: M
authors.lastname: Saito
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tsubata
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Shuichi
authors.initials: S
authors.lastname: Murakami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kuroda
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Junichi
authors.initials: J
authors.lastname: Fujisawa
authors.forename: Takehiro
authors.initials: T
authors.lastname: Murai
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakano
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
authors.forename: Fumitake
authors.initials: F
authors.lastname: Gejyo
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000150:complications*; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000382:microbiology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005384:Finger Joint / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009175:Mycoplasma Infections / Q000150:complications / Q000175:diagnosis*; D019535:Mycoplasma hominis; D011859:Radiography