Mycoplasma pneumoniae Periprosthetic Joint Infection Identified by 16S Ribosomal RNA Gene Amplification and Sequencing

Abstract

Chronic, culture-negative septic arthritis represents a major clinical dilemma. It often results in prolonged courses of antimicrobial therapy, which may or may not have activity against the organism responsible for the infection. It is not possible to cultivate all types of pathogens in vitro with use of traditional laboratory testing methods, but emerging techniques can be helpful to define the etiology of these infections in some cases. We describe a case of a periprosthetic joint infection in a thirty-year-old woman with juvenile rheumatoid arthritis (JRA) and hypogammaglobulinemia, who developed septic arthritis after prolonged pneumonia. She received multiple courses of antimicrobial therapy without improvement of the joint symptoms. The microbiologic diagnosis was made with use of 16S ribosomal RNA (rRNA) gene amplification and sequencing from synovial fluid and tissue. The patient gave permission for this information to be submitted for publication. A thirty-year-old woman with JRA and hypogammaglobulinemia was referred for evaluation of an infection at the site of a total knee arthroplasty. Her JRA had been managed with multiple courses of corticosteroids, infliximab, and, more recently, rituximab. She had undergone bilateral shoulder and knee synovectomy, and right elbow synovectomy, and finally had required left total knee arthroplasty in 2006. In the fall of 2009, the patient was hospitalized because of pneumonia, which had a prolonged course, with several hospitalizations due to recurrences over two months. Chest radiographs confirmed right upper lobe pneumonia, which later progressed to bilateral pneumonia. She was treated with azithromycin and ceftriaxone and initially showed improvement, but she then had a relapse with recurrent symptoms. During the multiple relapses, she was treated with vancomycin and cefepime followed by ertapenem. She had five bronchoscopy procedures. The bronchoscopies all showed purulent secretions, but all cultures were negative, including fungal and mycobacterial cultures. Polymerase chain reaction (PCR) for Mycoplasma pneumoniae …