Case Report
Volume 13 Issue 6 - 2022
Septic Polyarthritis with Super-Imposed Tophaceous Gout in Untreated HIV Disease: A Rare Manifestation
Trollip S1 and Chikanza IC2*
1Department of Medicine, Lusaka Apex Medical School, Lusaka, Zambia
2Department of Rheumatology, The Royal London Hospital, London, United Kingdom and Catholic University, Harare and Medical School, Univ of Zimbabwe, Harare, Zimbabwe
*Corresponding Author: Chikanza IC, Department of Rheumatology, The Royal London Hospital, London, United Kingdom and Catholic University, Harare and Medical School, Univ of Zimbabwe, Harare, Zimbabwe.
Received: April 19, 2022; Published: May 18, 2022


Untreated HIV infection eventually leads to immunosuppression predisposing an individual to various infective conditions including septic arthritis as well as HIV-associated rheumatic and musculoskeletal disorders (RMDs). Untreated HIV infection can worsen a pre-existing RMD by enhancing the inflammation present. We report a case of a 32-year-old male of African descent in Zambia, who presented with a history polyarthritis, fever, newly diagnosed with HIV and chronic alcohol use. He had no symptoms or signs of other connective tissue diseases. He presented with overt joint tenderness and swelling with tophi and fluctuance in several joints including a discharging tophus. Investigations revealed neutrophilic leukocytosis with raised CRP, ESR, uric acid, HIV viral load and a low CD4 count. RF and ACCP were both negative and the GGT was elevated. Joint discharge analysis showed very high neutrophil count, staphylococcus aureus on microscopy and culture and monosodium urate crystals were also noted on microscopy. A diagnosis of septic polyarthritis and tophaceous gout in flare with untreated HIV was made. The patient was treated with intravenous antibiotics, oral steroids, omeprazole and non-steroidal anti-inflammatory drugs (NSAIDs). Our case highlights how patients with HIV can present with RMDs and this poses a challenge with treatment as co-morbidities often complicate clinical presentations and management of patients with musculoskeletal disorders especially when infections are involved. This is because steroids and other immunosuppressants are used in treating RMDs and when there is a co-morbid infectious condition, correct treatment decisions must be made to manage all the co-existing conditions simultaneously. We report here the rare association of untreated HIV, gout and septic arthritis.


Keywords: Septic Arthritis; Rheumatic and Musculoskeletal Disorders; HIV; Tophaceous Gout


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Citation: Trollip S and Chikanza IC. “Septic Polyarthritis with Super-Imposed Tophaceous Gout in Untreated HIV Disease: A Rare Manifestation”. EC Orthopaedics 13.6 (2022): 12-17.

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