Giovannini-Sanguineti Giancarlo, Hanze-Villavicencio Karen, Sanchez-Vegas Carolina
Department of Pediatrics, Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA.
Department of Pediatric Infectious Diseases, Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA.
IDCases. 2021 Apr 30;24:e01145. doi: 10.1016/j.idcr.2021.e01145. eCollection 2021.
A 2-year-old, previously healthy, male presented with an insidious history of intermittent left knee pain and edema who had been evaluated in the emergency department on multiple occasions with unremarkable imaging and normal laboratory results. On the day of presentation, he had mild edema of the left knee and inability to bear weight. Synovial fluid analysis showed an elevated white cell count with neutrophil predominance and mildly elevated inflammatory markers, consistent with septic arthritis. He underwent knee arthrotomy with irrigation and debridement and was initiated on broad spectrum antibiotics. Cultures were negative, polymerase chain reaction for MRSA and were negative. He was started on a fifth-generation cephalosporin with resolution of symptoms, marked clinical improvement and normalization of inflammatory markers. The identification of the etiologic agent was possible due to detection of bacterial 16S rRNA gene amplification by PCR for in the synovial fluid. He completed a course of 3 weeks of parenteral antibiotics at home with full recovery.
一名2岁、既往健康的男性患儿，有隐匿性间歇性左膝疼痛和水肿病史，曾多次在急诊科就诊，影像学检查无异常，实验室检查结果正常。就诊当天，他左膝轻度水肿，无法负重。滑液分析显示白细胞计数升高，以中性粒细胞为主，炎症标志物轻度升高，符合化脓性关节炎。他接受了膝关节切开冲洗和清创术，并开始使用广谱抗生素。培养结果为阴性，耐甲氧西林金黄色葡萄球菌聚合酶链反应结果也为阴性。他开始使用第五代头孢菌素治疗，症状缓解，临床显著改善，炎症标志物恢复正常。通过对滑液进行聚合酶链反应检测细菌16S rRNA基因扩增，得以确定病原体。他在家中完成了为期3周的静脉抗生素治疗，完全康复。
