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Letter
Polymicrobial septic arthritis in a patient with Wilson’s disease
  1. A M Oliver,
  2. J W Baddley,
  3. S L Bridges, Jr
  1. University of Alabama at Birmingham, Alabama, USA
  1. Correspondence to:
    Dr S L Bridges Jr, Division of Clinical Immunology and Rheumatology, 415 Lyons-Harrison Research Building, University of Alabama at Birmingham, Birmingham, AL 35294–0007, USA;
    lbridges{at}uab.edu

https://doi.org/10.1136/ard.62.7.693

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    Septic arthritis should be excluded in patients with new onset inflammatory polyarthritis and a history of organ transplant on immunosuppressive drugs or diabetes. Unusual organisms or polymicrobial joint infection may be present, even in the absence of bacteraemia or abnormal radiographs, and a history of prior infections may provide valuable clues.

    CASE REPORT

    A 35 year old white man was seen for pain and swelling in both wrists and the right knee for about three weeks. He was diagnosed with Wilson’s disease at age 23 and underwent orthotopic liver transplant for cirrhosis one year later. Past history included personality disorder, choreiform movements, hypertension, diabetes mellitus, and renal insufficiency (serum creatinine 220–330 μmol/l). There were no symptoms of carpal tunnel syndrome. The drugs he was taking were prednisone 10 mg/day, mycophenolate mofetil 1000 mg twice daily, atenolol, and insulin. He had taken cyclosporin until six months previously, but it was discontinued because of worsening renal insufficiency. He had an intrahepatic abscess due to Enterococcus faecalis six months previously, which was treated with drainage and several weeks of intravenous ampicillin and gentamicin …

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