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October 20, 1978

Occult Chronic Septic Arthritis Due to Proteus mirabilis

Author Affiliations

From the Department of Medicine, University of Alabama in Birmingham, School of Medicine.

JAMA. 1978;240(17):1889-1890. doi:10.1001/jama.1978.03290170071034

A MAN with long-standing adult Still's disease1 had a Proteus mirabilis arthritis of the hip a year following an intra-articular injection of 30 mg of prednisolone tebutate. Despite appropriate antibiotic therapy and no symptoms suggestive of a continued pyarthrosis, he still had the same organism in the hip at successful joint replacement more than six months later. To my knowledge, it has not previously been clearly demonstrated that such infections may follow a protracted course of this relatively benign nature.

Report of a Case  A 36-year-old man had a recurring febrile illness since the age of 18 years, ultimately diagnosed as late-onset Still's disease. In 1971, bilateral hip arthritis was first noted, and his long-standing prednisone therapy was permanently discontinued because of increasing side effects. In March 1975, an attack of pain in the left hip and shoulder was unresponsive to 150 mg/day of indomethacin, and approximately 30 mg