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A rare cause of oligoarthritis with septic presentation
  1. Patrick Hoversten1,
  2. Joel Beachey1,
  3. Michael Pham2,
  4. Anjali Bhagra3
  1. 1 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Rheumatology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  3. 3 General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Anjali Bhagra, bhagra.anjali{at}


A 33-year-old man presented with new-onset, asymmetric, migratory oligoarthritis in the setting of several weeks of nausea and vomiting, diarrhoea, fevers and dysuria. He was initially treated in the inpatient setting with broad-spectrum antibiotics due to concern for an evolving sepsis presentation. Arthrocentesis of a large right knee effusion revealed inflammatory synovial fluid without findings suggestive of septic arthritis. Human leucocyte antigen B27 was positive and, taken together with the antecedent history of gastroenteritis, dysuria and inflammatory oligoarthritis, the clinical diagnosis was most consistent with reactive arthritis. Antibiotics were discontinued. His treatment course proved refractory to non-steroidal anti-inflammatory drugs and intra-articular and systemic glucocorticoid therapy with concurrent use of sulfasalazine and ultimately necessitated treatment with a tumour necrosis factor alpha inhibitor.

  • musculoskeletal and joint disorders
  • infection (gastroenterology)
  • rheumatology
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  • Contributors PH, JB and MP were involved in manuscript draft and literature review. AB was involved in manuscript draft as well as critical review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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