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This case highlights the fact that TNF may not be so important in the immunological elimination of pneumococcal infections, or more broadly, the eradication of organisms involving the humoral system. Learning points This is the first case report to the best of our knowledge that reports the re-institution of anti-tumour necrosis factor (TNF) therapy in treated septic prosthetic joints with complete resolution of rheumatoid arthritis (RA) symptoms in the patient and with no recurrence of infection. The successful treatment of prosthetic joint infections is dependent on eliminating the biofilm-dwelling EPZ5676 price microorganisms while maintaining the patient's mobility and quality of life. The extent of the biofilm may vary from organism to organism. This case challenges our current thinking for the use of anti-TNF therapy in the management of rheumatoid arthritis patients with serious infections. Footnotes Contributors: NM was the primary care physician. He wrote and submitted the article. GH and DS edited the article and provided intellectual input. AB was the surgeon who performed the arthroscopy and managed the patient in the acute stage of disease. He reviewed the article. MAPK Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed.A 66-year-old non-vegetarian man presented with increasing generalised weakness for 1?month. He also reported numbness and tingling in his extremities for the same time period. The physical examination was significant for pale appearance and generalised weakness. Laboratory results LY2109761 revealed pancytopenia, with white blood cell(WBC) count of 1310/?L (normal range (NR), 4�C11?k/?L), haemoglobin 5.5?g/dL (NR, 13�C17?g/dL), haematocrit 16.3% (NR, 39�C51%), platelets 55?000/?L (NR, 150?000�C400?000/?L) and mean cell volume (MCV) 113.2?fL (NR, 80�C100?fL) with red blood cell distribution width of 24.5% (NR 11.5�C15%). Peripheral blood WBC differential counts were: 53% neutrophils, 36% lymphocytes, 4% monocytes, 5% eosinophils, 1% basophils and 1% myelocytes. The red blood cells exhibited macrocytosis, anisocytosis, moderate ovalocytosis and polychromasia, while platelets were diminished. Total serum bilirubin was 1.6?mg/dL (NR, 0�C1.5?mg/dL), aspartate aminotransferase 106?U/L (NR, 7�C40?U/L), alanine transaminase 52?U/L (NR, 5�C50?U/L), serum lactate dehydrogenase >2500?U/L (NR,100�C220?U/L), haptoglobin20?ng/mL (NR, 2.8�C18?ng/mL), reticulocytes 1.1% (NR, 0.4�C2.0%) and vitamin B12 level