Septic arthiritis due to Prevotella bivia in a patient with rheumatoid arthirits

Prevotella bivia is a gram-negative anaerobic bacteria traditionally classi fied in the genus Bacteroides, and usually reported in obstetric and gyneco logic infections. To date, there has been only one description of infectiou s arthritis secondary to this germ. We report the first case of septic arth ritis due to Prevotella bivia in a patient with severe, long-lasting rheuma toid arthritis (RA) treated with low doses of corticosteroids. RA is a well -known predisposing factor to septic arthritis, whose causes are multifacto rial (general immunosuppression induced by the disease and its therapy, pre sence of prosthetic joints, etc.). However, infectious arthritis due to ana erobic bacteria is rarely observed. In general, clinical presentation varie s widely: insidious onset, apyrexia, and lack of inflammatory signs or syst emic disturbance are frequent features. Joint infection is generally second ary to hematogenous spread, the Bacteroides fragilis group being the most c ommonly isolated pathogens. Early diagnosis and prompt treatment, with drai nage and debridement of the affected joint and specific antimicrobial treat ment with Metronidazole are essential for a successful outcome. (C) 2000 Ed itions scientifiques et medicales Elsevier SAS.