A twenty-two-month-old boy with septic hip arthritis had persistent elevated inflammatory markers and daily fevers despite multiple antibiotic regimens and repeated surgical debridements yielding negative cultures. After exhaustive work-up for other infectious, rheumatologic, and immunologic etiologies, he met diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH) and developed cultures positive for fungal hip arthritis. Following treatment for HLH and fungal hip arthritis, he improved and was discharged.
No previous report in the literature specifically associates HLH with septic hip arthritis, to our knowledge. Surgeons should suspect underlying immunologic deficiencies and atypical infectious causes of septic arthritis when usual treatment modalities have failed.
1Department of Orthopaedic Surgery, University of Michigan, Mott Children’s Hospital, SPC 4241, 1540 East Medical Center Drive, Ann Arbor, MI 48109
2Department of Orthopaedic Surgery, Wayne State University, 18100 Oakwood Boulevard, Dearborn, MI 48124
3Department of Pediatrics and Communicable Diseases, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109