Martonovich Noa, Reisfeld Sharon, Yonai Yaniv, Behrbalk Eyal
Orthopedic Surgery Department Hillel Yaffe Medical Centre, Hadera, Israel.
Rappaport Faculty of Medicine Technion, Haifa, Israel.
Case Rep Rheumatol. 2024 Jun 25;2024:2608144. doi: 10.1155/2024/2608144. eCollection 2024.
Pyomyositis, accompanied by aseptic arthritis, has been previously documented in several publications. However, none of the authors in the mentioned case reports offered a pathophysiological explanation for this unusual phenomenon or proposed a treatment protocol. We present a case of a healthy, 70-year-old male who was presented to the emergency department 4 days after tripping over a pile of wooden planks and getting stabbed by a nail to his thigh. The right thigh was swollen. Unproportional pain was produced by a light touch to the thigh. A laboratory test and a CT scan were obtained. The working diagnosis was pyomyositis of the thigh and septic arthritis of the ipsilateral knee. The patient underwent urgent debridement and irrigation of his right thigh. An arthroscopic knee lavage was performed as well. Intraoperative cultures from the thigh revealed the growth of and . Cultures from synovial fluid were sterile; thus, septic arthritis was very unlikely. The source of the knee effusion might have been an aseptic inflammatory response due to the proximity of the thigh infection. Anatomically, the quadriceps muscle inserts on the patella, and its tendon fuses with the knee capsule, creating a direct fascial track from the thigh to the knee. The inflammatory response surrounding the infection may have followed this track, creating a domino effect, affecting adjacent capillaries within the joint capsule, and causing plasma leakage into the synovial space, leading to joint effusion. Our suggested treatment is addressing the primary infection with antibiotics and considering adding anti-inflammatory therapy, given our suspicion that this process has an inflammatory component.
伴有无菌性关节炎的脓性肌炎此前已在多篇文献中有所记载。然而，上述病例报告的作者均未对这一异常现象给出病理生理学解释，也未提出治疗方案。我们报告一例健康的70岁男性病例，该患者在被一堆木板绊倒并被钉子刺伤大腿4天后被送往急诊科。右大腿肿胀，轻触大腿会产生不成比例的疼痛。进行了实验室检查和CT扫描。初步诊断为大腿脓性肌炎和同侧膝关节化脓性关节炎。患者接受了右大腿的紧急清创和冲洗，同时也进行了膝关节镜下灌洗。大腿术中培养显示有[具体细菌名称1]和[具体细菌名称2]生长。滑膜液培养无菌，因此化脓性关节炎的可能性极小。膝关节积液的来源可能是由于大腿感染临近导致的无菌性炎症反应。从解剖学角度来看，股四头肌附着于髌骨，其肌腱与膝关节囊融合，形成了一条从大腿到膝关节的直接筋膜通道。感染周围的炎症反应可能沿着这条通道蔓延，产生多米诺效应，影响关节囊内相邻的毛细血管，导致血浆渗漏到滑膜腔，进而引起关节积液。我们建议的治疗方法是使用抗生素治疗原发性感染，并考虑添加抗炎治疗，因为我们怀疑这一过程存在炎症成分。
