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Related Experiment Videos

Misdiagnoses: a timely reminder.

W R Marshall1, J E Leggett

  • 1Department of Surgery, Oregon Health Sciences University, Portland.

Annals of Plastic Surgery
|November 1, 1992
PubMed
Summary
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An occult infection mimicking palindromic arthritis was misdiagnosed for two years. Removing infected breast implants resolved recurrent fever, myalgias, and arthralgias, confirming the bacterial cause.

Area of Science:

  • Infectious Diseases
  • Rheumatology
  • Plastic Surgery

Background:

  • Occult infections can present with non-specific symptoms, leading to diagnostic challenges.
  • Palindromic arthritis is a rare condition characterized by recurrent episodes of joint inflammation.
  • Silicone implants are generally considered inert but can be a nidus for infection.

Observation:

  • A patient presented with nearly two years of misdiagnosed palindromic arthritis and recurrent erysipelas.
  • Symptoms included episodic fever, myalgias, and arthralgias, initially suspected to be autoimmune in origin due to prior silicone implantation.
  • Coagulase-negative staphylococci were identified within the valve stems of bilateral breast implants.

Findings:

  • The occult infection was caused by coagulase-negative staphylococci residing in the breast implant valve stems.

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  • Surgical removal of the infected bilateral breast implants led to complete resolution of the patient's symptoms.
  • The patient remained symptom-free post-explantation, indicating successful eradication of the infection.

    • Implications:

    • Highlights the importance of considering occult infections in patients with prosthetic devices presenting with atypical inflammatory symptoms.
    • Underscores the potential for bacterial colonization of implant components, even years after placement.
    • Suggests that thorough investigation and removal of infected implants are crucial for resolving prosthetic joint infection mimics.