SEPTIC ARTHRITIS AS A COMPLICATION OF ORALLY GIVEN STEROID THERAPY

• Septic arthritis developed in two patients while they were on steroid therapy. One, a woman aged 34, had received corticotropin, cortisone, hydrocortisone, and prednisone at various times over a period of years in the treatment of lupus erythematosus. The severe, destructive septic arthritis that developed about the left knee was remarkable because of the absence of pain and fever. It was successfully treated with chloramphenicol and streptomycin. The other patient, a man aged 54, had a recurrent generalized exfoliative dermatitis treated at various times with prednisone, corticotropin, and hydrocortisone. The septic arthritis that developed in this patient involved one knee and both hands and resulted in complete dislocation of the left index finger; it was likewise characterized by comparative freedom from either pain or fever. It is very difficult in such cases to distinguish a developing septic arthritis from a preexisting arthritis for which the patient is being treated. A diagnostic aspiration of material from the affected joints should be done early.