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Reactive Arthritis Caused by Haemophilus parainfluenzae in a Diabetic Patient

Published:November 29, 2018DOI:https://doi.org/10.1016/j.amjmed.2018.11.007
      We report the first likely known case of reactive arthritis caused by Haemophilus parainfluenzae. An 84-year-old woman developed polyarthritis of the neck, shoulders, and hips. Two months prior to admission, she had received dental treatment for caries; 1 week later, she noted fever and extremity pain. Physical examination revealed that the range of motion of both shoulders was limited to approximately 60°, in abduction and forward flexion, secondary to pain. Laboratory tests showed that the erythrocyte sedimentation rate, C-reactive protein, and serum amyloid A were 99 mm/h, 4.0 mg/dL, and 109.9 μg/mL, respectively. The white blood cell count was elevated (11.9 × 103/μL) with neutrophil predominance (81.8%); the hemoglobin was 9.8 g/dL. Blood glucose and hemoglobin A1c were 216 mg/dL and 9.0%, respectively. Other blood test results, liver enzymes, renal function, serological tests, and urinalysis results were normal. Radiographs of the shoulder, femoral, and knee joints revealed no deformities. Computed tomography showed no remarkable findings. Whole-body gallium scintigraphy revealed marked uptake in the tendon attachments of both shoulders and hips (Figure). Pharyngeal bacterial culture grew H. parainfluenzae, susceptible to ampicillin (ABPC). The patient was treated with 750 mg/d of ABPC for 3 months. Her symptoms improved, and she was followed-up for 1 year, without relapse.
      Figure
      FigureGallium scintigraphy findings. (A) Coronal section and (B, C) axial on gallium scintigraphy show marked uptake (arrows).
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