Polyarticular septic arthritis

Case report

A 54 year old man was admitted to hospital with polyarthritis affecting both knees and the right wrist. His only medical history was of intermittent episodes of sciatica over the past 14 years. In January 2005 he developed a “bad cold” with a headache and sore throat, along with back pain and sciatica. Five days later he had severe pain and swelling affecting both knees and the right wrist. His polyarthritis was so severe that he was unable to walk and spent four days lying on the floor before his admission to hospital.

On admission, nine days after his first symptoms, he had a fever of 38.3ºC and acutely hot swollen knees and right wrist. No neurological signs were present. The admitting team believed that he had reactive arthritis but asked the orthopaedic surgeons to rule out septic arthritis of the right wrist. The orthopaedic opinion was that septic arthritis was unlikely on clinical grounds, and a rheumatology review was suggested.

By the next morning, the patient appeared very unwell and …