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Mycobacterium celatum-induced septic arthritis: case report A 63-year-old woman developed Mycobacterium celatum induced septic arthritis during treatment with adalimumab, leflunomide and methylprednisolone for rheumatoid arthritis (RA) [routes, durations of treatments to reaction onset and outcome not stated; not all dosages stated]. The woman, who had a history of RA since 2001, experienced swelling and pain of her right wrist during the previous year despite treatment with methylprednisolone 6mg and leflunomide. Physical examination revealed synovitis of her right wrist and tenderness in several proximal interphalangeal joints in both hands with prolonged early morning stiffness. Subsequently, adalimumab was included in her treatment following appropriate screening. Two months later, the right wrist was more painful and massively swollen with a cherry red cystic mass over the ulnar head. She exhibited low-grade fever throughout the previous few days. Investigations showed only a 3 fold increase in C-reactive protein (CRP) levels. Based on these findings and clinical presentation, septic arthritis associated with adalimumab, leflunomide and methylprednisolone was suspected. The woman’s treatment with leflunomide and adalimumab was discontinued. Bone and synovial biopsies were performed surgically. The Lowenstein Jensen slants (LJ) slants of both synovial samples were positive. Ziehl-Neelsen stain that was carried out in all positive LJ slants showed the presence of acid-fast bacteria that were identified to the species level by the blot hybridisation assays. Culture studies revealed the isolates as Mycobacterium celatum. Based on these findings and clinical presentation, a confirmed diagnosis of Mycobacterium celatum induced septic arthritis associated with adalimumab, leflunomide and methylprednisolone was made. Daoussis D, et al. First report of Mycobacterium celatum-induced arthritis. Rheumatology 59: 1772-1773, No. 7, Jul 2020. Available from: URL: http://doi.org/10.1093/ 803502026 rheumatology/kez586

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Reactions 19 Sep 2020 No. 1822