TITLE:
A Large, Inflamed Knee, Pulling down the Wolf Mask
AUTHORS:
Bachir Mansour Diallo, Jean Noel Ndour, Nana Mamoudou Baba, Fulgence Abdou Faye, Yanidou Ndiaye, Adama Wade, Nelson Nandong, Serigne Abdou Khadr Mbaye, Adama Berthé, Papa Souleymane Touré, Madoky Magatte Diop, Mamadou Mourtalla Ka
KEYWORDS:
Systemic Lupus Erythematosus (SLE), Pseudo-Septic Arthritis, Monoarthritis, Autoantibodies, Synovitis
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.12 No.10,
October
16,
2024
ABSTRACT: Introduction: Joint manifestations are common in systemic lupus, affecting multiple joints or just one. These manifestations are present in 95% of patients. Pseudo-septic arthritis is a subset of systemic lupus that mimics septic arthritis caused by the deposition of lipid droplets in the joint. We present the case of a patient hospitalized for mono-arthritis, which revealed systemic lupus. Observation: The patient is a 19-year-old woman, single, without children, and with no previous medical history, who was hospitalized for fever and inflammatory polyarthralgia. The clinical examination revealed an inflammatory swelling of the right knee with patellar ballottement, yellow citrine synovial fluid, an inflammatory tumor on the left arm, which was round, mobile, and fluctuating with purulent content, edema of the lower limbs, and facial puffiness, along with a systemic inflammatory response syndrome. Paraclinical examination showed hyperleukocytosis with neutrophil predominance, microcytic anemia, thrombocytopenia, antistreptolysin O (ASLO) 3, suggesting inflammatory arthritis. Bacteriological tests did not isolate any pathogens. An arthrotomy with synovial biopsy was performed, and the histopathological examination supported non-specific synovitis. A joint ultrasound showed signs of arthritis with a septic appearance. During the third hospitalization for persistent fever, she presented with facial puffiness, anemia syndrome, systemic inflammatory response syndrome, and a malar rash across the bridge of the nose. Antinuclear antibodies returned positive with a titer of 1280 and a speckled fluorescence pattern, and anti-native DNA antibodies were positive at 60.1 (normal Conclusion: Pseudo-septic arthritis is a feature of lupus that can mimic septic arthritis. Monoarticular involvement is rare but possible. The absence of pathogens and the inflammatory nature of the synovial fluid should prompt consideration of a lupus-related etiology.