Septic arthritis and Reiter's syndrome in sickle cell disorders: case reports and implications for management

Two patients with sickle cell disorders developed gram-negative septic arthritis and responded poorly to conventional managment. Unfavorable factors included (1) confusion with the nonseptic arthropathy of a sickle crisis; (2) impaired articular perfusion, perhaps related to local sickling; (3) conversion of an infecting organism to an L-form in the presence of cell-wall inhibitors; and (4) interference with cultures and antibacterial titrations of synovial fluid caused by intro-articular administration of antibiotics. Prolonged treatment with very high doses of antibiotics was required to eradicate infection in both patients. Because sickling and local hypoxia apparently interfere with defenses against infection, anemia should be corrected by transfusion. One patient had had Reiter's syndrome; the dysenteric form of this disease may be a cause of arthritis in some sicklemic patients.