Case report: post-Covid-19 arthritis and peri arthritis
Swiss Medical Weekly
; 152(Supplement 261):24S, 2022.
Article
in English
| EMBASE | ID: covidwho-2057851
ABSTRACT
We present the case of a 63 years old male patient known for type 2 diabetes and sleep apnoea. He was admitted as inpatient for a nontraumatic severe and disabling left hip pain. The pain started progressively one month ago. The medical history was otherwise irrelevant, with no general symptoms nor other symptoms suggestive of an inflammatory disease. To mention a history of an asymptomatic SARS-COV2 infection, diagnosed by a naso-pharyngial PCR, approximately 10 days before the onset of the pain. On physical examination, the patient was afebrile. The palpation of the inguinal region was tender on palpation with marked limitation of the hip range of motion. The spine and other peripheral joints were painless without inflammatory sign. Moreover, there was no skin lesion nor inguinal lymph nods enlargement. Due to the importance of pain with marked functional limitation, the patient is hospitalized for investigations and pain-management. On blood sample there was a mild increase of inflammatory markers (CRP 25mg/l, VS 20mm/h) with normal cell count. Standard X-rays of the pelvis and hip were normal. The MRI of the hip showed a mild coxo-femoral arthritis with marked inflammation of the surrounding musculature. An arthrocentesis was performed and 2ml of serous fluid was aspirated. There were no crystals. The cellularity could not be tested due to small amounts of fluid. The synovial culture showed a polymicrobious growth compatible with contamination. In summary, we were facing a patient with an acute and very painful hip monoarthritis. There was no history of gastrointestinal or urinary tract infection, the search for C. trachomatis and N. gonorrhoea in urines was negative. An extensive serologic testing (HIV, HBV, HCV, HBV, HCV, HIV, Lyme, Syphilis, Coxiella, Bartonella, Brucella & Quantiferon) and the search for T. whipplei were negative as well. There was no HLA-B27 and rheumatoid factor, ACPA, ANA, ANCA and specific antibodies related to polymyositis were negative. The chest-abdomen-pelvis scan showed no sign of neoplasia. To rule out a vasculitis we proceeded to a PET-CT, which showed no sign of vasculitis or myositis. Considering the timing of the onset of the symptoms and the absence of any other diagnosis, the patient was diagnosed with reactive arthritis caused by SARS-COV2. The patient was treated with Diclofenac 150 mg/day and opioids. The clinical evaluation one month after discharge showed a spontaneous significant improvement.
adult; analgesia; arthrocentesis; asymptomatic coronavirus disease 2019; Bartonella; blood sampling; Brucella; case report; cell count; Chlamydia trachomatis; clinical article; clinical evaluation; conference abstract; coronavirus disease 2019; Coxiella; diabetes mellitus; drug combination; drug therapy; gastrointestinal infection; Hepatitis C virus; hip pain; hospital patient; human; Human immunodeficiency virus; inflammation; inguinal region; lymph; male; medical history; middle aged; monarthritis; myositis; Neisseria gonorrhoeae; neoplasm; non insulin dependent diabetes mellitus; nonhuman; nuclear magnetic resonance imaging; palpation; pelvis; periarthritis; pharynx; polymyositis; positron emission tomography-computed tomography; range of motion; reactive arthritis; Severe acute respiratory syndrome coronavirus 2; skin defect; sleep disordered breathing; spine; syphilis; thorax; Tropheryma whipplei; urinary tract infection; vasculitis; X ray; cyclic citrullinated peptide antibody; diclofenac; endogenous compound; HLA B27 antigen; neutrophil cytoplasmic antibody; opiate; rheumatoid factor
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Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Case report
Topics:
Long Covid
Language:
English
Journal:
Swiss Medical Weekly
Year:
2022
Document Type:
Article
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