Mirle Vikranth, Gamsarian Vahram, Krishnan Aditya, Brusalis Christopher, Forsythe Brian
Department of OrthopaedicMidwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopaedic Surgery and Rehabilitation, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
J Orthop Case Rep. 2023 Jun;13(6):127-132. doi: 10.13107/jocr.2023.v13.i06.3722.
Non-classical Celiac disease is a previously undescribed cause of debilitating post-operative cutaneous complications following an orthopedic procedure. Non-specific symptoms and rarity of the disease pose a diagnostic challenge; however, given underdiagnosis and significant morbidity, after ruling out of acute pathology, Celiac disease should be included in differential diagnosis for refractory cutaneous complications following an operative procedure.
A 34-year-old woman who underwent patellofemoral arthroplasty and medial patellofemoral ligament reconstruction experienced over 5 months of post-operative knee swelling, erythema, and pain unresponsive to antihistamines and negative infectious, vascular, and implant allergy testing workups. After careful dietary monitoring by an allergy specialist, she was tested and confirmed to have Celiac disease. Following cessation of her oral contraceptive pill and dietary gluten, her knee swelling, erythema, and debilitating pain resolved.
Skin erythema, swelling, and pain are known complications after any operative treatment, but after ruling out of acute infectious and thromboembolic processes, diagnosis and management of refractory complications pose a challenging scenario. In this rare phenomenon, previously undescribed, a patient presented with months of post-operative knee erythema, swelling, stiffness, and extreme pain on activity along with non-specific symptoms of headache and fatigue before diagnosis with Celiac disease. On cessation of her birth control and dietary gluten, her symptoms and knee function improved dramatically.
非典型乳糜泻是一种先前未被描述的导致骨科手术后出现严重皮肤并发症的病因。该疾病症状不具特异性且较为罕见，这给诊断带来了挑战；然而，鉴于其诊断不足及显著的发病率，在排除急性病变后，乳糜泻应纳入手术后继发性难治性皮肤并发症的鉴别诊断中。
一名34岁女性接受了髌股关节置换术和髌股内侧韧带重建术，术后5个多月膝关节持续肿胀、发红且疼痛，使用抗组胺药治疗无效，感染、血管及植入物过敏检测结果均为阴性。在过敏专科医生进行仔细的饮食监测后，她被检测并确诊为乳糜泻。停用口服避孕药并避免摄入含麸质食物后，她的膝关节肿胀、发红及严重疼痛症状均得到缓解。
皮肤发红、肿胀和疼痛是任何手术治疗后已知的并发症，但在排除急性感染和血栓栓塞过程后，难治性并发症的诊断和管理具有挑战性。在这种先前未被描述的罕见现象中，一名患者在被诊断为乳糜泻之前，术后数月出现膝关节发红、肿胀、僵硬以及活动时极度疼痛，并伴有头痛和疲劳等非特异性症状。停用避孕药并避免摄入含麸质食物后，她的症状及膝关节功能显著改善。
