Acute COVID-Related Hip Arthritis. Case Report and Literature Review

INTRODUCTION: 2 years after the SARS-CoV-2 outbreak which is responsible for the COVID-19 pandemic, the clinical presentations remain unclear and unpredictable. The disease can present with a heterogeneous clinical course and a wide spectrum of clinical manifestations which can cause various complications from different systems, including musculoskeletal. CASE REPORT: The case of a young, fit, and healthy female patient with severe onset of hip pain which started only shortly after being tested positive for COVID-19 infection is presented in this study. There is no history of rheumatologic disease. Clinical assessment did not show any signs of erythema at the hip region, however, on palpation, there was significant tenderness at the anterior aspect of the left hip joint. The patient was unable to bare weight on this hip and could not straight leg raise, and the rotation of the hip was severely restricted due to underlying pain. The nasopharyngeal swabs for SARS-Vo2 were performed and came back positive. The CRP was 205 and plain anteroposterior radiograph of the pelvis did not show abnormalities. A diagnostic aspiration under sedation in theaters was offered; the culture and enrichment were negative for infection. Since the symptoms were not improving with conservative measures, an open washout of the joint cavity was performed in theatres. The microbiologists guided on the antibiotic treatment and adequate analgesia was prescribed. Symptoms settled very soon after the open procedure and the requirements for analgesics were reduced to minimal use. The following couple of days, the pain, range of movement, and mobility significantly improved, and the patient returned within 2 weeks back to her normal activities. The rheumatologists organized a complete screening which ruled out elements of seronegative disease. In the final, 6-month follow-up, the patient was totally symptom free, and the blood markers were entirely unremarkable. CONCLUSION: This is the first case of COVID-19-related, hip arthritis recorded worldwide, in a patient without any predisposing factors. Clinical suspicion is the key for early diagnosis and treatment for every COVID-19-positive patient with musculoskeletal symptoms, even for the patients with no history of autoimmune diseases. Viral-related arthritis remains a diagnosis of exclusion and underlies the importance to perform all the test to rule out other possible inflammatory arthritis. Our experience showed that early irrigation of the joint cavity is related with efficient symptoms relief, less requirement for analgesia, less time in hospital, and quicker return to daily activities.