Signs of sepsis may be obscure in patients with rheumatoid arthritis, particularly in association with long-term steroid therapy. If mortality is to be avoided, a high index of suspicion must be maintained for the diagnosis, and doubtful joints should be aspirated for culture and prompt therapy with the correct antibiotic. In this report a patients with advanced rheumatoid arthritis presented with bilateral shoulder dislocation due to septic arthritis. Ultrasonography was particularly helpful in guiding a 20 G needle to fluid collections with the debris-filled joint capsules and in facilitating successful aspiration. Ultrasound also provided a painless, noninvasive, and safe method of serial assessment of the joints after therapy.
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