1/21. Septic arthritis of the hip associated with atopic dermatitis. A case report.We report a case of septic arthritis of the hip associated with atopic dermatitis. A 15-year female felt a pain in the right hip with unknown cause on May 11, 1998. The pain subsequently became aggravated, and she was admitted to our hospital on May 18. She has had atopic dermatitis since 4 years of age. She showed generalized dermatitis with desquamation and numerous scratch marks. A culture of both skin and joint fluid revealed staphylococcus aureus. physical examination revealed tenderness in Scarpa triangle and restricted range of motion. Immunological serology showed an increase in eosinophils and immunoglobulin e, and a decreased reaction of lymphocyte blastoid transformation. Computed tomography (CT) and MRI showed a joint effusion in the right hip. She was diagnosed as having septic arthritis of the hip. Intravenous drip of cefazolin of 2g was started on the first day of hospitalization and joint irrigation was done on the second day. CRP became negative at 4 weeks, but joint effusion was shown on CT. Additional joint irrigation with Amicamycin (200 mg) was done. As the joint fluid culture became negative, range of motion exercises were started at 6 weeks. She was discharged with a long-leg brace applied at 8 weeks. At 13 months after onset, she had complete relief of the pain and normal activities of daily living. No destructive changes in the hip were found on X-ray examination or MRI. In the present case, an abnormal immune system associated with atopic dermatitis as well as the habit of scratching eruptions may have led to hematogenous spread of skin infection, and caused septic arthritis of the hip.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/21. Patient with a limp.A 50 year old man, previously well, attends his general practitioner complaining of seven days of limping and left hip pain. Examination reveals: blood pressure 150/85, pulse 110 and regular, temperature 37.9 degrees C. The left hip is irritable with decreased range of motion. The following investigations are arranged with subsequent results: full blood examination: white cell count 16 (normal 4-11) with neutrophilia c-reactive protein: elevated. Left hip X-ray (Figure 1) shows joint space narrowing, poor definition of the articular surfaces and surrounding osteoporosis.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/21. Septic arthritis of the hip caused by yersinia enterocolitica: a case report.We report a case of bacteriologically documented hip infection caused by yersinia enterocolitica. A 67-year-old male with a history of valvular disease was admitted for pain and motion range limitation in the left hip with a fever. No organisms were recovered by needle aspiration, but yersinia enterocolitica grew in joint fluid obtained by surgical arthrotomy. Investigations of the gastrointestinal tract were normal, and there was no evidence of endocarditis. After 6 weeks of appropriate antibiotic therapy and immobilization with transtibial traction, the clinical and laboratory test abnormalities improved. However, the patient died from an intercurrent condition. Y. enterocolitica, a well-known cause of reactive arthritis, can cause septic arthritis.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
4/21. Aeromonas hydrophilia infections after penetrating foot trauma.The bacterium aeromonas hydrophila is an anaerobic gram-negative bacillus commonly found in natural bodies of water and can cause infection in patients who suffer water-associated trauma or in immunocompromised hosts. The authors present 5 cases of penetrating wound trauma that did not involve any aquatic environment and developed rapidly forming infections. All patients presented with severe pain, cellulitis, ascending lymphangitis, fever, and pain on range of motion of the joint near the traumatic site. Presentation of clinical symptoms mimicked that of a septic joint or of severe streptococcal infection. All patients required surgical incision and drainage, intravenous and oral antibiotics using levofloxacin or bactrim, and local wound care. Results from cultures taken intraoperatively showed only A hydrophilia in every case. Resolution of symptoms occurred rapidly after surgery, and clinical resolution was seen within 72 hours. Each patient healed uneventfully and returned to preinjury status.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
5/21. An unusual pattern of arthritis in a child with Kawasaki syndrome.arthritis is reported in one-third of cases with Kawasaki syndrome. It may have an early or a late onset form. We present a 15-month-old-girl who had been referred with complaints of pain and swelling in her left shoulder. physical examination revealed bulbar conjunctival injection, erythematous lips and pharynx, strawberry tongue, erythematous rash, edema and erythema of the left shoulder, left knee, right elbow and right wrist, and moderate distress in the left shoulder and left hip. She was diagnosed with Kawasaki syndrome, and intravenous immunoglobulin infusion (IVIG) 2 g/kg and aspirin (100 mg/kg/day) were instituted. The patient had two additional episodes of arthritis involving the hip joint on the 8th day, and the shoulder and metacarpophalangeal (MCP) and interphalangeal (IP) joints of her right hand on the 15th day. Turbid material was aspirated in both instances; Gram and Wright's staining of this material showed many leukocytes but no bacteria. A second dose of IVIG (1 g/kg) was given. At the end of the third week all extremities were painless, with a normal range of motion. arthritis in our patient was the presenting sign, having a 'septic arthritis mimicking' and 'biphasic' pattern. Although the patient presented with severe and recurrent arthritis, which is significantly correlated with severe multisystem disease and the presence or development of coronary artery aneurysm, the response to IVIG was excellent.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
6/21. Septic arthritis in the adult caused by streptococcus pneumoniae: a report of 4 cases and review of the literature.OBJECTIVES: To identify coexistent diseases, clinical features, approaches to management, and predictors of outcome in patients with pneumococcal septic arthritis. methods: Case series of 4 adults with streptococcus pneumoniae septic arthritis seen at a university hospital, plus a review of 115 adults with pneumococcal septic arthritis reported in the medical literature from 1973 through 2003. RESULTS: Among our 4 patients, 3 had polyarticular infections, joint prostheses were involved in 1, 3 had underlying joint diseases, and 1 had concurrent meningitis. infection was caused by penicillin-intermediate/cephalosporine-susceptible S pneumoniae in 1 patient and penicillin-resistant/cephalosporine-intermediate S. pneumoniae in 1 patient. After a mean treatment duration of 6 weeks, all patients were clinically cured of infection. review of the literature identified 115 cases of S pneumoniae septic arthritis in adults. Clinical data were available for 107 patients. Twenty-nine cases were polyarticular (26%), joint prostheses were involved in 15 patients (13%), and 61 patients had underlying joint disease (57%). meningitis was a concurrent infection in 15 cases. The presumed primary focus of infection was the respiratory tree in 44 patients. Ninety-six percent of cases were caused by penicillin-susceptible organisms. Cure of infection with survival was achieved in 83% (79 of 95) of patients with native joint septic arthritis and in 67% (8 of 12) of patients with prosthetic joint infection. A good functional outcome (full range of motion or return to baseline range of motion) after infection was achieved by 44 of 71 patients (62%) with native joint infection and by 4 of 7 patients (57%) with infections of prosthetic joints. The likelihood of cure of infection or good functional outcome was not influenced by method of joint drainage. CONCLUSIONS: S pneumoniae is an uncommon, but not rare, cause of septic arthritis in the adult. Many patients have underlying joint disease (especially rheumatoid arthritis) and coexistent alcoholism. Although most infections involve native joints, prosthetic joint infections comprise 13% of cases. Polyarticular disease occurs in approximately one quarter of patients. Most patients have a preceding or concurrent extra-articular focus of pneumococcal infection. To date, the majority of reported infections are caused by penicillin-susceptible organisms, so penicillin g or a third-generation cephalosporine such as ceftriaxone remains the appropriate treatment option. However, infection with drug-resistant organisms is likely to be an increasing problem in the future. With directed antimicrobial therapy and appropriate joint drainage, the outcome is generally good for patients with native joint infections. In contrast, only two thirds of patients with infections of prosthetic joints survive their infections. Approximately 40% of surviving patients experience functional impairment or chronic pain as a sequelae of their infection.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/21. Arthroscopic treatment for septic arthritis of the shoulder in an infant.We report a case of septic arthritis in the shoulder of an infant treated with a combination of arthroscopic irrigation, debridement, and synovectomy. The results were encouraging. The patient was a boy who was 2 years 6 months of age. His first symptoms were a body temperature of 40 degrees C and right upper arm pain. Five days after the onset, he was brought to our institution. His shoulder was swollen and erythematous. Yellowish fluid (7 ml) was aspirated from his shoulder joint; the causative organism was group A Streptococcus. On admission, arthroscopic surgery was performed. His temperature gradually decreased, and inflammatory markers including the white blood cell count and c-reactive protein level improved. At his 1-year follow-up there was no sign of infection, and a full range of motion in the shoulder was maintained. The interval between the onset and the start of treatment is an important factor affecting the prognosis. The patient was brought to our institution 5 days after onset and underwent arthroscopic surgery on the same day. This early treatment was one of the factors that contributed to a successful result. Arthroscopic surgery, including irrigation and debridement, may be one of the options for treating septic arthritis of an infant's shoulder.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/21. gout, have we met before? No, not like this...learning OBJECTIVES: Extra-articular symptoms could be the first manifestation of gouty arthritis (GA); polyarticular GA can mimic an infectious arthritis; infection can complicate GA. CASE: A 66-year-old male with a history of gout presented with high fever and excruciating bilateral calf pain for 1 day. Examination revealed chronic knee effusions; range of motion in both knees was limited by calf pain. Joint aspiration showed negatively birefringent intracellular crystals and normal gram stain. HOSPITAL COURSE: While receiving empiric antibiotics fever continued and he developed bilateral knee, right ankle, and shoulder pain. After demonstration of urate crystals and exclusion of infection, antibiotics were discontinued and steroids initiated. fever, calf pain, and polyarthritis quickly resolved. DISCUSSION: Polyarticular gouty attack is an uncommon presentation of gout, and can mimic several other conditions. An exceptional presentation of this entity is excruciating calf pain, probably caused by tenosynovitis or referred pain preceding an acute polyarticular gouty attack.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
9/21. Septic monarthritis due to pasteurella multocida after a cat scratch in a patient with rheumatoid arthritis.A 60-yr-old woman with a history of seropositive rheumatoid arthritis and using a low dose of corticosteroids presented with a very painful, swollen, red coloured knee with limited range of motion. physical examination revealed a scratch on her left lower leg without discolouration or induration. synovial fluid cultures yielded pasteurella multocida. The pathogenetic significance of this commensal of cats and dogs in man is discussed.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
10/21. Mixed gonococcal and mycobacterial sepsis of the wrist.Mycobacterial infections of the hand and wrist are rare. Concurrent infection of a joint by more than one organism is also unusual. A 25-year-old man developed wrist sepsis caused by neisseria gonorrhoeae and mycobacterium avium intracellularis. The infection was successfully treated by wrist drainage, carpal debridement, and intravenous antibiotics. Secondary carpal reconstruction was accomplished by delayed bone grafting and internal fixation to preserve radiocarpal motion.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
| | Next -> |