Asif Adnan, Saran J S R G, Kumar N K Arun
Department of Orthopaedics, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India.
Department of Orthopaedics, M V J Medical College, Bengaluru, Karnataka, India.
J Orthop Case Rep. 2025 Sep;15(9):37-42. doi: 10.13107/jocr.2025.v15.i09.6006.
Septic arthritis is an acute condition of the joints that warrants an emergency procedure of joint arthrotomy with debridement, IV antibiotics postoperatively and commonly affects big joints, which include the hip, knee, and shoulder. Serratia marcescens causing septic arthritis is quite rare and is mainly seen in immunocompromised individuals, and very limited literature is present pertaining to the same.
A 65-year-old male patient presented to the hospital with sudden inability to bear weight on his right lower limb, inability to flex the knee, which was associated with swelling of the knee, and the limb was externally rotated for 3 days. A fracture of the right neck of the femur was identified on X-ray of the pelvis with bilateral hips. There was no history of trauma. He is a known case of chronic kidney disease for 3 years and is also a known hypertensive and type 2 diabetes mellitus for 15 years, and is currently undergoing dialysis thrice per week. The affected knee was aspirated and was found to have S. marcescens infection, localized there itself; blood culture and intraoperative hip aspirate were negative for the same organism. He underwent right knee arthrotomy with synovectomy and was started on IV antibiotics based on the culture and sensitivity report.
Septic arthritis of the knee joint, along with pathological fracture of the neck of the femur in immunocompromised patients, has to be addressed and given special focus for diagnosis and treatment. Swelling of the knee with inability to flex and acute pain is a sign of septic knee and joint aspiration and antibiotic cover is the mainstay of the treatment, but in cases of acute septic knee, it will require knee arthrotomy with synovectomy and joint debridement.
化脓性关节炎是一种关节急性病症，需要紧急进行关节切开清创术，术后静脉注射抗生素，且通常累及大关节，包括髋、膝和肩部。由粘质沙雷氏菌引起的化脓性关节炎相当罕见，主要见于免疫功能低下的个体，与之相关的文献非常有限。
一名65岁男性患者因右下肢突然无法承重、膝关节无法屈曲伴膝关节肿胀且肢体向外旋转3天入院。骨盆双侧髋关节X线检查发现右股骨颈骨折。无外伤史。他是一名已知患有3年慢性肾脏病的患者，同时患有高血压和2型糖尿病15年，目前每周接受三次透析。对患侧膝关节进行穿刺抽吸，发现有粘质沙雷氏菌感染，局限于该部位；血培养和术中髋关节穿刺抽吸未发现该菌。他接受了右膝关节切开滑膜切除术，并根据培养和药敏报告开始静脉注射抗生素。
免疫功能低下患者的膝关节化脓性关节炎伴股骨颈病理性骨折必须得到诊治，并在诊断和治疗上给予特别关注。膝关节肿胀伴无法屈曲和剧痛是化脓性膝关节炎的体征，关节穿刺抽吸和使用抗生素是主要治疗方法，但对于急性化脓性膝关节炎病例，需要进行膝关节切开滑膜切除术和关节清创术。
