Cobalt hip prosthesis intoxication mimicking an autoimmune disease |
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| Affiliation: | 1. Rheumatology Department, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy;2. Experimental Medicine, University of Pavia, Pavia, Italy;1. Centre d’Évaluation et Traitement de la Douleur, Hôpital Cochin, Université Paris Descartes, 75014 Paris, France;2. INSERM U987, 92100 Boulogne Billancourt, France;3. EA 7537, Faculté de pharmacie de Paris, Université Paris Descartes, 75006 Paris, France;4. Service de biostatistiques et d’informatique médicales, hôpital Saint-Louis, Assistance publique–hôpitaux de Paris, 75010 Paris, France;5. Association Française des Polyarthritiques (AFP Ric), 9, rue de Nemours, 75011 Paris, France;1. Clinic of Rheumatology, Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy;2. Université Sorbonne Paris Nord, Li2P, Bobigny, France;3. Inserm U1125, Bobigny, France;4. Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Rheumatology Department, Bobigny, France;5. Rheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy;1. Service de rhumatologie, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 01, France;2. Service de rhumatologie, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France |
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| Abstract: | Cobalt-containing hip prosthesis may cause systemic toxicity due to the release of cobalt from metal-on-metal (MoM) joint arthroplasty into the bloodstream. High cobalt blood levels can lead to a variety of clinical manifestations, mimicking other disorders, especially autoimmune, hematologic, and infectious diseases. Our purpose is to describe a clinical case of cobalt hip prosthesis intoxication mimicking an autoimmune disease, with systemic inflammation signs, arthro-myalgias unrelated to overt synovitis, and multiple autoantibody positivity. A 69-years-old woman presented with a 1-year history of right coxalgia, recurrent fever, arthro-myalgias, mediastinal and right iliac reactive lymphadenopathy. She underwent hip replacement surgery seven years earlier. The physical examination was unremarkable except for right hip pain. Laboratory tests showed markedly increased inflammatory indices and microbiological tests were all negative. Ultrasound-guided arthrocentesis of right hip yielded limpid fluid with negative cultures. Increased cobalt levels in plasma and urine showed metal intoxication. Magnetic resonance imaging with metal artifact reduction sequence (MARS) confirmed a periprosthetic mass as usually seen in reaction to metal debris. Prosthesis substitution was performed with a resolution of the clinical picture and normalization of cobalt levels. |
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| Keywords: | Cobalt toxicity Arthro-myalgia Fever of unknown origin Pseudotumor Autoantibody positivity Metal artefact reduction sequence |
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