Haemophilus influenzae infection of a prosthetic knee joint in a patient with rheumatoid arthritis

A 60-year-old female was admitted to internal medicine with a painful left knee after a fall and pneumonia. She had undergone a primary cemented left total knee arthroplasty in 2019 and a right cemented total knee arthroplasty in 2021. She had also a history of rheumatoid arthritis treated with steroids and a Janus kinase 1 (JAK1) inhibitor (upadacitinib). On admission intravenous antibiotic therapy was started for the treatment of pneumonia (piperacillin/tazobactam). Because of the persistent left knee pain, a knee puncture was carried out and confirmed a periprosthetic infection. A peripheral blood culture taken on admission day showed Haemophilus influenzae. She underwent a knee arthrotomy with debridement, irrigation, explantation of the knee prosthesis and spacer placement. Intraoperative cultures showed Haemophilus influenzae. The isolate was identified as a nontypeable Haemophilus influenzae strain by the reference laboratory. Haemophilus influenzae strains rarely cause invasive diseases. Rheumatoid arthritis with immunosuppressive therapy may have predisposed this patient to severe invasive disease. The clinical presentation of an infection may differ markedly in patients with rheumatoid arthritis from that in patients without rheumatoid arthritis or immunosuppression.