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Hematogenous patellar osteomyelitis associated with human immunodeficiency virus.

T P Vail1, J R Urbaniak

  • 1Division of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.

Orthopaedic Review
|September 1, 1991
PubMed
Summary

This case study highlights rare patellar osteomyelitis in an HIV-positive man. Early diagnosis and treatment are crucial for managing this severe knee infection.

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Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Immunology

Background:

  • Hematogenous osteomyelitis is uncommon in the patella, typically affecting adolescents and immunocompromised individuals.
  • No prior cases of patellar hematogenous osteomyelitis in human immunodeficiency virus (HIV)-positive patients have been documented.
  • This study presents a unique case and literature review of this rare condition.

Observation:

  • A 37-year-old male with HIV presented with clinical and radiographic evidence of patellar osteomyelitis and knee pyarthrosis.
  • Key diagnostic signs included point tenderness over the patella and a painful, swollen knee joint.
  • Laboratory studies and systemic symptoms were not significantly indicative of the infection.

Findings:

  • Computed tomography (CT) proved valuable in diagnosis.
  • Initial treatment involved intravenous antibiotics and surgical debridement of the patella and knee joint.
  • Despite aggressive management, the patient experienced recurrent pyarthroses, necessitating amputation.

Implications:

  • This case underscores the importance of clinical suspicion for diagnosing patellar osteomyelitis in immunocompromised patients, including those with HIV.
  • Prompt and appropriate treatment, including antibiotics and surgical intervention, is essential.
  • The case highlights potential challenges in managing severe infections, sometimes leading to limb-threatening complications.

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