Henderson R C, Rosenstein B D
Division of Orthopaedic Surgery, University of North Carolina, Chapel Hill 27599.
Clin Orthop Relat Res. 1989 Nov(248):261-4.
A 26-year-old black male with sickle-cell disease developed a Salmonella septic arthritis in one knee and an acute, aseptic arthritis in the other knee. Salmonella is showing increasing resistance to many antibiotics. In this patient, optimal antibiotic treatment of his uncommon infection was delayed by a rare resistance to trimethoprim-sulfamethoxazole. Two pathophysiologic mechanisms could account for his acute, aseptic arthritis: sickle-cell disease with presumed synovial ischemia from sickling and reactive arthritis precipitated by a remote Salmonella infection elsewhere in the body. The authors could find no previous discussion of either of these processes in the orthopedic literature. Acute arthritis in a patient with sickle-cell disease can be a complex diagnostic and therapeutic problem.
一名患有镰状细胞病的26岁黑人男性，一侧膝关节发生沙门氏菌感染性关节炎，另一侧膝关节出现急性无菌性关节炎。沙门氏菌对多种抗生素的耐药性正在增加。在该患者中，由于对甲氧苄啶-磺胺甲恶唑罕见的耐药性，其不常见感染的最佳抗生素治疗被推迟。两种病理生理机制可解释其急性无菌性关节炎：镰状细胞病导致镰变引起滑膜缺血，以及身体其他部位的远处沙门氏菌感染引发反应性关节炎。作者在骨科文献中未发现此前对这两种过程的任何讨论。镰状细胞病患者的急性关节炎可能是一个复杂的诊断和治疗问题。
