Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI, USA.
Am J Emerg Med. 2021 May;43:287.e5-287.e7. doi: 10.1016/j.ajem.2020.09.043. Epub 2020 Sep 23.
Septic arthritis is an important but difficult to make diagnosis that leads to significant morbidity and mortality. Joint effusion is generally accepted to be a highly sensitive finding in septic arthritis; however, final diagnosis requires synovial fluid studies. Without a significant joint effusion, it is difficult to obtain synovial fluid. In this case report, we describe the presentation and diagnosis of septic arthritis in the first MTP due to mycobacterium chelonae in a 69 year old man with a history of gout and immunosuppression due to a heart transplant. There was notably no significant effusion in the joint on clinical examination or bedside ultrasound. As the patient was immunosuppressed, arthrocentesis was performed under ultrasound guidance. A needle was clearly visualized in the joint; however, minimal synovial fluid was obtained. The fluid grew Mycobacterium chelonae in culture. Subsequent joint washout revealed purulent synovial fluid that grew out the same bacteria. This case emphasizes the importance of obtaining synovial fluid to evaluate for septic arthritis, even when joint effusion is absent. Ultrasound guidance can facilitate this.
化脓性关节炎是一种重要但难以诊断的疾病，可导致严重的发病率和死亡率。关节积液被普遍认为是化脓性关节炎的高度敏感发现；然而，最终诊断需要进行滑液研究。如果没有明显的关节积液，很难获得滑液。在本病例报告中，我们描述了一位 69 岁男性因痛风和心脏移植后免疫抑制导致的龟分枝杆菌引起的第一跖趾关节化脓性关节炎的表现和诊断。临床上或床边超声检查均未见关节明显积液。由于患者免疫抑制，在超声引导下进行了关节穿刺。关节内可清楚显示针头；然而，只获得了少量的滑液。该液体在培养中生长出龟分枝杆菌。随后的关节冲洗显示出脓性滑膜液，其中也生长出相同的细菌。本病例强调了即使没有关节积液，也需要获取滑膜液来评估化脓性关节炎，这一点很重要。超声引导可以促进这一过程。
