Abstract
Objective: Skin lesions of atopic dermatitis are highly colonized with gram-positive bacteria, which may enter the blood stream through the broken skin barrier. This paper described the association between atopic dermatitis and septic arthritis in an attempt to emphasize the importance of a high index of clinical suspicion for the correct diagnosis of bacterial arthritis in patients with atopic dermatitis. Methods: We reported one and two infections of sacroiliac joint and knees, respectively, in patients with atopic dermatitis. A systematic search of the literature revealed one case of septic arthritis of hip joint in association with atopic dermatitis. We discussed the clinical features and treatment of the articular infections. Results: In combination with localized pain, elevation of white blood cells, erythrocyte sedimentation rate, and Creactive protein indicated hematogenous articular infection in the patients at the age of 13-27 with poorly controlled atopic dermatitis. Magnetic resonance imaging was useful to identify deep articular infections. Staphylococcus aureus was the predominant pathogen, while group A streptococcus was less frequently isolated. For confirmation of the causative bacteria and spectrum of antibiotic sensitivities, skin culture was helpful in case of negative identification of the pathogen from culture of synovial fluid. Treatment with antibiotics against Staphylococcus aureus and group A streptococcus with or without surgical management resulted in good outcome. Conclusion: This case series was the first report suggesting the association between septic arthritis and atopic dermatitis. Patients with poorly controlled atopic dermatitis may be at high risk of septic arthritis because the broken skin barrier could become a potential portal of pathogens.
Highlights
Acute monoarticular arthritis has multiple potential etiologies including infection, crystalloid arthropathies, rheumatoid arthritis, lupus, and trauma [1,2,3]
Septic arthritis is usually secondary to bacteremia because the lack of basement membrane in the synovial tissue makes bacterial organisms readily enter the synovial fluid through hematogenous route
Screening of the reference lists revealed a case of septic arthritis of hip joint in association with Atopic Dermatitis (AD) [10]
Summary
Acute monoarticular arthritis has multiple potential etiologies including infection, crystalloid arthropathies, rheumatoid arthritis, lupus, and trauma [1,2,3]. The most serious condition is septic arthritis. Septic arthritis has an annual incidence of 10 per 100,000 individuals in the United States and is more common among those with rheumatoid arthritis or a prosthetic joint, with up to 70 cases per 100,000 [4]. Septic arthritis most commonly affects the knee, which accounts for approximately 50% of cases. In decreasing order of frequency, septic arthritis affects the hip, shoulder, and elbow [5]. Septic arthritis is usually secondary to bacteremia because the lack of basement membrane in the synovial tissue makes bacterial organisms readily enter the synovial fluid through hematogenous route. Delayed or inadequate treatment of septic arthritis results in irreversible joint destruction with subsequent disability because articular cartilage can be destroyed within days. Prompt diagnosis to facilitate appropriate antibiotic management of septic arthritis is critical [6]
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