Department of orthopaedic surgery, Herzogin Elisabeth Hospital Braunschweig, Leipziger Str. 24, 38124, Braunschweig, Germany.
Orthopadie (Heidelb). 2023 Oct;52(10):843-847. doi: 10.1007/s00132-023-04415-0. Epub 2023 Aug 20.
A 60-year-old female was admitted to internal medicine with a painful left knee after a fall and pneumonia. She had undergone a primary cemented left total knee arthroplasty in 2019 and a right cemented total knee arthroplasty in 2021. She had also a history of rheumatoid arthritis treated with steroids and a Janus kinase 1 (JAK1) inhibitor (upadacitinib). On admission intravenous antibiotic therapy was started for the treatment of pneumonia (piperacillin/tazobactam). Because of the persistent left knee pain, a knee puncture was carried out and confirmed a periprosthetic infection. A peripheral blood culture taken on admission day showed Haemophilus influenzae. She underwent a knee arthrotomy with debridement, irrigation, explantation of the knee prosthesis and spacer placement. Intraoperative cultures showed Haemophilus influenzae. The isolate was identified as a nontypeable Haemophilus influenzae strain by the reference laboratory. Haemophilus influenzae strains rarely cause invasive diseases. Rheumatoid arthritis with immunosuppressive therapy may have predisposed this patient to severe invasive disease. The clinical presentation of an infection may differ markedly in patients with rheumatoid arthritis from that in patients without rheumatoid arthritis or immunosuppression.
一位 60 岁女性因跌倒和肺炎后出现左侧膝关节疼痛而被收入内科。她曾于 2019 年接受过左侧初次水泥固定全膝关节置换术，于 2021 年接受过右侧水泥固定全膝关节置换术。她还患有类风湿关节炎，曾接受类固醇和 Janus 激酶 1（JAK1）抑制剂（upadacitinib）治疗。入院时，因肺炎（哌拉西林/他唑巴坦）开始静脉注射抗生素治疗。由于持续的左膝疼痛，进行了膝关节穿刺并证实为假体周围感染。入院当天采集的外周血培养显示流感嗜血杆菌。她接受了膝关节切开术清创、灌洗、膝关节假体取出和间隔物放置。术中培养显示流感嗜血杆菌。参考实验室鉴定分离株为非典型流感嗜血杆菌株。流感嗜血杆菌株很少引起侵袭性疾病。类风湿关节炎伴免疫抑制治疗可能使该患者易患严重的侵袭性疾病。感染的临床表现在类风湿关节炎患者与无类风湿关节炎或免疫抑制的患者可能有明显差异。
