Hip Pelvis.  2012 Dec;24(4):328-332. 10.5371/hp.2012.24.4.328.

Acute Phase of Sero-negative Rheumatoid Arthritis Misdiagnosed as Pyogenic Arthritis: A Case Report

• Park CH
• Lee JH
• Kim TJ
• Hurr D
• Chun YS
• Rhyu KH
• Cho YJ

• KMID: 1425050
• DOI: http://doi.org/10.5371/hp.2012.24.4.328

Abstract

In cases of sero-negative rheumatoid arthritis (RA), no abnormal findings are observed on blood tests and its clinical course is favorable, compared to sero-positive RA. In the acute phase of sero-negative RA, infiltration of neutrophils may be the only pathologic finding on frozen section biopsy. Thus, it might be misdiagnosed as pyogenic arthritis. We report on a case of acute sero-negative RA misdiagnosed as pyogenic arthritis during hip surgery with review of the literature.

Keyword

Hip; Seronegative rheumatoid arthritis; Pyogenic arthritis

MeSH Terms

Arthritis
Arthritis, Rheumatoid
Biopsy
Frozen Sections
Hematologic Tests
Hip
Neutrophils

Figure

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  Fig. 1 Preoperative radiographs of the hip joint showing sclerotic change of both femoral head, subchondral bone cysts & fracture, joint destructive change. (A) AP view, (B) Frogleg view.

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  Fig. 2 MRI view showing joint fluid collection, synovial hypertrophy, subchondral bone cyst & fracture. (A) T1 weighted coronal view (B) T2 weighted coronal view.

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  Fig. 3 Postoperative radiographs showing antibiotics pregnated cement spacer insertion of the right hip joint.

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  Fig. 4 (A) Histologic examination of hematoxyline and eosin stained specimen showed of neutrophils infiltration in the tissues around the hip joint and did not show the lymphoid follicle (×100). (B) The same findings above figure (×400), (C) Small pannus (dark arrow) formation ingrowing cartilage (×100).

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