Chronic destructive oligoarthritis associated with Propionibacterium acnesin a female patient with acne vulgaris - Septic-reactive arthritis?

Propionibacterium acnes is an anaerobic bacillus implicated in certain chro nic arthritides. This report describes an HLA-B27+ 17-year-old woman with a cne vulgaris who presented with rapidly destructive arthritis in the left s houlder as well as an evolving left subclavicular adenopathy, One year late r, arthritis was detected in the left knee; the inflammatory synovial fluid was sterile, Growth of P acnes was observed in cultures of the shoulder sy novium and lymph nodes, but polymerase chain reaction was negative for Borr elia, Chlamydia, and Ureaplasma DNA, Three months of treatment with amoxici llin and rifampicin led to clinical disappearance of the oligoarthritis, bu t arthritis recurred in the left knee after discontinuation of therapy, On biopsy, bacteria were undetectable in the knee synovium, but chronic arthri tis was evident histologically. Antibiotics were reintroduced for 12 months and were again effective against the clinical symptoms. Although the asymm etry, histologic features, arthritis-acne association, and genetic predispo sition of this chronic destructive oligoarthritis would seem to indicate a reactive arthropathy, the isolation of P acnes from 2 distinct specimens pr ompted us to propose calling this a case of septic-reactive arthritis, whic h is further supported by the absence of progression after antibiotic thera py and the persistence of the rheumatism. To our knowledge, this is the fir st demonstration of the efficacy of prolonged antibiotic therapy on the joi nt manifestations of chronic rheumatism associated with acne.