Acute synovitis, fever and rash possibly caused by metallic debris from a loosened knee prosthesis in a patient with rheumatoid arthritis

A 39-year-old woman with long-standing seropositive rheumatoid arthritis wh o had a total replacement of her left knee with a modular prosthesis in 199 4 presented with fever, pruritic rash, and acute synovitis of that joint fo llowing local trauma. Synovial fluid showed a charcoal-like color, and cont ained abundant phagocytes laden with metal particles. In patients with rheu matoid arthritis who have undergone total joint replacement, metal particle reactions and possible hyper-sensitivity should be added to the list of po tential causes of superimposed acute synovitis and systemic manifestations.