Batna Journal of Medical Sciences
Volume 9, Numéro 1, Pages 83-87
2026-01-02

Septic Polyarthritis With Fatal Outcome In Rheumatoid Arthritis: A Consequence Of Corticosteroid Injection And Unsupervised Immunosuppressive Polypharmacy



Authors : Slimani Samy .

Abstract

Septic polyarthritis is a rare but severe form of septic arthritis, associated with high morbidity and mortality, particularly in patients with rheumatoid arthritis receiving immunosuppressive therapy. We report the case of a 44-year-old woman with longstanding, deforming seropositive rheumatoid arthritis, who developed fulminant polyarticular septic arthritis following a corticosteroid injection into the wrist. Within five days, arthritis extended to multiple large joints, accompanied by fever and sepsis. Before hospitalization, the patient self-administered excessive doses of methotrexate, daily leflunomide, and dual high-dose nonsteroidal anti-Inflammatory drugs, leading to severe bone marrow aplasia and profound immunosuppression. Blood cultures yielded methicillin-sensitive Staphylococcus aureus. Imaging revealed widespread infection involving joints, soft tissues, thoracic wall, lungs, and peritoneum. Despite urgent surgical drainage, broad-spectrum intravenous antibiotics, and subsequent regimen adjustment for acute kidney injury, the infection progressed to septic shock with multiorgan failure, resulting in death on day 20 of hospitalization. This case highlights how advanced rheumatoid arthritis, intra-articular corticosteroid injection, and unsupervised immunosuppressive polypharmacy combined to cause a rapidly fatal infection. It stresses that routine procedures can trigger catastrophic outcomes in vulnerable patients, and underscores the need for early recognition, aseptic technique, prudent patient selection, and strict monitoring of immunosuppressive therapy.

Keywords

Rheumatoid Arthritis; Septic Arthritis; Methotrexate; Intra-Articular Injections; Fatal Outcome

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