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Dimitrios Daoussis, Fotini Angelopoulou, Pantelis Kraniotis, Catastrophic brucella hip arthritis, Rheumatology, Volume 58, Issue 3, March 2019, Page 417, https://doi.org/10.1093/rheumatology/key264
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A 56-year-old livestock farmer was referred to the Rheumatology Clinic with a 6-month history of pain and reduced range of motion of the right hip. He denied any systemic symptoms and his medical history was unremarkable. On examination the right hip joint was very painful and had markedly decreased range of motion. A plain X-ray (Fig. 1A) showed destruction of the right hip whereas his lab tests revealed only a 3-fold increase in CRP levels. A pelvic MRI (Fig. 1B) was suggestive of a septic process and therefore joint aspiration was performed. The relatively long course of the disease, the lack of fever and the low CRP levels pointed towards microorganisms of low virulence. Brucella was included in the differential diagnosis because the patient had occupational exposure and was living in an endemic area of southwestern Greece. Brucella serology was positive and the microbiology lab was notified of the high clinical suspicion of brucellosis. Of note, Brucella is a slow growing microorganism and cultures should run for an extended period before they are discarded as negative. The diagnosis was finally confirmed by synovial fluid culture. The patient was started on long term antibiotic treatment with a favourable response.
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