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Recurrent arthritis as presenting symptom of osteomyelitis
S E Haine1, V J Reenaers, J F Van Offel
1University Hospital of Antwerp, Antwerp (UIA), Belgium.
Abstract:
We present a patient who had one episode of prepatellar bursitis and subsequently several episodes of arthritis of his right knee. Cultures of several punctures of his knee remained sterile, but the patient had been taking oral antibiotics on each of these occasions against our medical advice. Ultimately a diagnostic puncture revealed growth of Staphylococcus aureus. An X-ray demonstrated an osteolytic lesion of the patella, but no defect in the articular surface of the patella could be visualised. MRI demonstrated a communication between the osteomyelitic focus through the medial retinaculum to the bursa suprapatellaris and the knee joint. Osteomyelitis of the patella is mainly a disease of childhood. This case is, to our knowledge, the first report on the association between bursitis, osteomyelitis of the patella and recurrent septic arthritis of the knee in an adult. The literature is reviewed and discussed briefly.
Insights
This case report details an adult with recurrent septic arthritis of the knee, initially presenting as prepatellar bursitis. It highlights the rare association of adult patellar osteomyelitis with knee joint infection.
Area of Science:
- Orthopedics
- Infectious Diseases
- Radiology
Background:
- Recurrent septic arthritis in adults is uncommon.
- Patellar osteomyelitis is primarily a pediatric condition.
- Prepatellar bursitis can sometimes mask deeper infections.
Observation:
- A patient experienced recurrent knee arthritis following prepatellar bursitis.
- Initial knee aspirations were sterile despite oral antibiotic use.
- Staphylococcus aureus was eventually cultured from the knee joint.
Findings:
- X-ray revealed an osteolytic lesion of the patella.
- MRI demonstrated a communication between patellar osteomyelitis and the knee joint via the medial retinaculum.
- This represents a rare adult case of associated bursitis, osteomyelitis, and septic arthritis.
Implications:
- Highlights the importance of thorough investigation in recurrent joint effusions, even after initial sterile cultures.
- Suggests patellar osteomyelitis can present insidiously in adults.
- Emphasizes the potential for contiguous spread from bone infection to the joint and bursa.