Division of Rheumatology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
BMJ Case Rep. 2021 Nov 2;14(11):e245583. doi: 10.1136/bcr-2021-245583.
A 33-year-old man presented with a 2-year history of right knee swelling with fungating masses and white-yellow discharge. Severe pain, limited movement and signs of sepsis were absent. Debridement, partial synovectomy and arthrotomy were done for the multiple sinuses that developed over the knee. Synovial tissue analysis yielded a positive acid-fast bacillus smear and PCR test, while aerobic culture studies grew and Chronic granulomatous inflammation was seen on histopathology. Alongside antibiotic therapy, multiple debridements of the right knee were required to eradicate the infection and allow wound repair. A flap coverage with split-thickness skin graft was performed after the bacterial infection resolved, and the patient was discharged ambulatory with minimal pain. Such atypical presentations of monarthritis require immediate workup and a prompt referral to a multidisciplinary team to establish the diagnosis and initiate appropriate management before irreversible joint destruction and disability ensues.
一位 33 岁男性，因右膝关节肿胀伴蕈样肿块和黄白色分泌物 2 年就诊。无剧烈疼痛、活动受限和脓毒症征象。为膝关节多处窦道行清创术、部分滑膜切除术和关节切开术。滑膜组织分析显示抗酸杆菌涂片和 PCR 检测阳性，需氧培养研究显示 ，组织病理学检查显示慢性肉芽肿性炎症。除抗生素治疗外，还需要多次清创以根除感染并允许伤口修复。待细菌感染得到控制后，进行皮瓣覆盖和断层皮片移植，患者出院时疼痛明显减轻，可活动。这种非典型的单关节炎表现需要立即进行检查，并迅速转介给多学科团队，以在不可逆转的关节破坏和残疾发生之前明确诊断并开始适当的治疗。
