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When should septic arthritis be suspected if a hemophiliac develops acute monoarthritis?
The presence of blood in the joint can act as a culture medium. The presence of fever and/or if the pain of a suspected hemarthrosis fails to improve after factor replacement, concomitant septic arthritis must be suspected and aspiration of the joint becomes mandatory. Notably, HIV infection in the setting of hemophilia is the most significant risk factor for septic arthritis. Any synovial fluid obtained on routine aspiration of a hemarthrosis should be submitted for Gram stain and culture. Staphylococcus aureus and Streptococcus pneumoniae are most common organisms identified.
Diagnostic Clues for Septic Arthritis Coexisting with Hemarthrosis
| Failure of joint pain to resolve with factor replacement | Previous arthrocentesis in the same joint |
| Fever >38°C | Presence of arthroplasties |
| Peripheral leukocytosis | Underlying joint damage (chronic arthropathy) |
| HIV infection | Intravenous drug use |
