ArticleFrontiers in medicine2026
Case Report: Sequencing-supported probable osteoarticular
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
Background: Osteoarticular Case description: A 52-year-old woman with an erosive seronegative rheumatoid arthritis phenotype and overlap autoimmune features developed progressive polyarticular swelling, wrist tenosynovitis, hip effusions, and low-back pain after cumulative immunosuppression. Investigations showed macrocytic anemia, lymphopenia, pan-hypogammaglobulinemia, marked B-cell depletion without anti-CD20 exposure, and cytomegalovirus DNAemia. Pre-treatment mNGS reported MAC-spectrum signals in hip, wrist, and elbow aspirates, including 355 right-hip reads. A separate pathogen-targeted joint-fluid sequencing report, with no anatomical site stated, detected MAC complex (116,330 normalized sequences; assay-estimated 10⁵ copies/mL). Neither result was interpreted as organism burden. No tissue histopathology, dedicated mycobacterial culture, or phenotypic susceptibility testing was performed. The working diagnosis was multisite sequencing-supported probable multifocal osteoarticular MAC infection without culture confirmation. Several interventions began concurrently. Selected follow-up MR images showed persistent destructive wrist disease and residual joint or periarticular fluid, but no standardized imaging or microbiological response endpoint was available. Conclusion: In atypical arthritis progressing during immunosuppression, infection-focused sampling should precede further escalation. mNGS can provide an etiologic clue, but culture, histopathology, targeted testing, and longitudinal reassessment remain essential.
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