Tufts University School of Medicine, Boston, Massachusetts, USA
Tufts University School of Medicine, Boston, Massachusetts, USA.
BMJ Case Rep. 2023 Jul 5;16(7):e255532. doi: 10.1136/bcr-2023-255532.
A man in his 40s with no prior orthopaedic history presented to an infectious disease clinic with persistent left knee pain and swelling following a traumatic meniscal tear and ensuing prodromal period of fever and chills. Aspiration of the left knee joint revealed a white cell count of 21.0 ×10/L (83% neutrophils) with negative Gram stain and culture. However, Lyme PCR was positive and accompanied by serologies consistent with Lyme arthritis. He was treated with a standard course of antibiotic therapy with subsequent resolution of joint effusion and significant improvement in pain.This is to our knowledge the first report in the literature of Lyme arthritis seemingly provoked by traumatic knee injury. We propose disruption of normal joint anatomy and ensuing inflammation in response to acute injury incited and accelerated migration of previously latent spirochetal infection into surrounding synovial tissue, leading to enhanced inflammatory activity and exacerbation of knee pain.
一位 40 多岁的男性，既往无骨科病史，因外伤性半月板撕裂和随后的前驱期发热和寒战，出现持续性左膝疼痛和肿胀，到感染病诊所就诊。左膝关节抽吸显示白细胞计数为 21.0×10/L（83%中性粒细胞），革兰氏染色和培养均为阴性。然而，莱姆 PCR 呈阳性，伴有莱姆关节炎的血清学一致。他接受了标准疗程的抗生素治疗，随后关节积液消退，疼痛明显改善。据我们所知，这是文献中首次报道外伤性膝损伤似乎引发莱姆关节炎。我们提出，正常关节解剖结构的破坏以及随后的炎症反应，可能会引发和加速先前潜伏的螺旋体感染向周围滑膜组织的迁移，导致炎症活性增强和膝痛加剧。
