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Hip joint infection by Prevotella denticola in rheumatoid arthritis : A case diagnosed with metagenomic sequencing
Rong Zhu1, Juan Zhang1, Hai-Li Shen2
1Department of Rheumatology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, Gansu, China.
Background:
Infection, as a complication of rheumatoid arthritis (RA), has attracted increasing attention from rheumatologists. Here, we present the first case of RA with hip joint infection, which was driven by infection with Prevotella denticola. Anaerobic bacterial infection was identified by metagenomic next-generation sequencing (mNGS).
Methods:
We describe the case of a 56-year-old woman with a history of RA who was admitted for intense hip joint pain and intermittent fever following long-term oral glucocorticoid (GC) treatment.
Results:
Although blood and hip joint effusion cultures for aerobic and anaerobic organisms were negative, we considered the possibility of a clinical diagnosis of hip joint infection; therefore, empirical antibiotic treatment was initiated but it was ineffective in this case. Prevotella denticola was identified by mNGS from the hip joint effusion obtained via ultrasound-guided puncture and the organism was resistant to the initial antimicrobial treatment. Finally, the adjustment of antimicrobial treatment led to successful treatment.
Conclusion:
Patients with RA have a significantly greater risk of infections than the general population; however, Prevotella denticola infection of the hip joint has not been previously reported. The combination of ultrasound-guided puncture and mNGS to accurately recognize and treat joint infection in patients with RA in a timely manner is necessary to prevent the development of complications, a strategy worthy of further clinical application.
Insights
This study reports the first case of hip joint infection in rheumatoid arthritis (RA) caused by Prevotella denticola. Metagenomic sequencing identified the anaerobic bacteria, leading to adjusted antibiotic treatment for successful patient recovery.
Area of Science:
- Rheumatology
- Infectious Diseases
- Microbiology
Background:
- Rheumatoid arthritis (RA) patients face increased infection risks.
- Hip joint infection is a rare but serious complication.
- Prevotella denticola is an anaerobic bacterium implicated in this case.
Purpose of the Study:
- To report the first case of RA with hip joint infection caused by Prevotella denticola.
- To highlight the utility of metagenomic next-generation sequencing (mNGS) in diagnosing rare infections.
- To emphasize timely and accurate diagnosis for effective management.
Main Methods:
- Case study of a 56-year-old female RA patient with hip pain and fever.
- Ultrasound-guided hip joint puncture for effusion collection.
- Metagenomic next-generation sequencing (mNGS) for pathogen identification.
- Empirical and adjusted antibiotic therapy.
Main Results:
- Standard cultures were negative for aerobic and anaerobic organisms.
- mNGS identified Prevotella denticola in hip joint effusion.
- Initial antibiotic treatment was ineffective due to organism resistance.
- Adjusted antimicrobial therapy resulted in successful treatment.
Conclusions:
- Prevotella denticola hip joint infection is a novel finding in RA patients.
- Ultrasound-guided puncture combined with mNGS is crucial for timely diagnosis.
- Prompt and accurate diagnosis and treatment are essential to prevent RA complications.
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