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associated with a collection that had peripheral contrast uptake&#44; compatible with small bone inflammation&#46; A CT was performed within 20 days&#44; and a 6-mm lytic lesion was seen in the posterior aspect of the medial femoral condyle&#44; with involvement of the cortical bone without any periosteal reaction observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Septic arthritis of the left knee by <span class="elsevierStyleItalic">Fusobacterium nucleatum</span>&#44; with secondary erosion of the left posterior femoral condyle&#46; Right maxillary sinusitis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Progression</span><p id="par0055" class="elsevierStylePara elsevierViewall">On admission&#44; parenteral antibiotic treatment was begun with cephotaxime and cloxacyllin&#46; After receiving the culture positive for <span class="elsevierStyleItalic">Fusobacterium nucleatum</span>&#44; we started treatment with intravenous metronidazole for 21 days&#46; Given the initial evolution showing marked swelling and flexion deformity of the joint&#44; we decided to perform the arthrotomy with debridement and partial synovectomy with surgical drainage and placement of a continuous lavage system&#44; which was maintained for 5 days&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">After discharge&#44; oral treatment continued for 2 weeks and the patient underwent rehabilitation&#46; The clinical course was favorable&#44; showing no residual deformity or loss of function&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In later visits&#44; a left knee CT and scintigraphy were performed and were normal&#44; with disappearance of the bone erosion&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Septic arthritis caused by anaerobic microorganisms is rare&#46; It is estimated that its prevalence is below 1&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and <span class="elsevierStyleItalic">Fusobacterium</span> spp&#46; is the most frequently found germ&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusobacterium</span> spp&#46; is a strictly anaerobic bacterium that is part of the flora of the oral&#44; vaginal and intestinal mucosa&#46; There have been reports of septic arthritis by this bacterium after dental procedures&#44; tonsillectomy&#44; dental abscess drainage and other pharyngeal infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> In the case of our patient&#44; there was a history of frequent otitis&#44; and signs of right maxillary sinus inflammation as potential risk factors&#44; with normal immunological tests&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusobacterium necrophorum</span> is the most virulent germ of the species&#44; classically associated with Lemierre syndrome&#44; which characteristically presents with thrombophlebitis of the internal jugular vein&#46; Only rarely does it cause septic arthritis&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusobacterium nucleatum</span> septic arthritis in immunocompetent patients is extremely rare&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with few published cases in children&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> Hence&#44; the peculiarity of the case is presented&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In septic arthritis it is important to establish a specific treatment early because of the possibility of rapid joint destruction&#44; which would be accompanied by an irreversible loss of functionality&#46; Treatment involves drainage of the joint along with appropriate antibiotic therapy&#46; Drainage can be accomplished through arthrocentesis&#44; arthroscopy&#44; or through open surgical drainage or arthrotomy&#44; as in this case&#46;</p></span></span>"
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Images in Clinical Rheumatology
Septic Arthritis Due to Fusobacterium nucleatum in an Immunocompetent Patient
Artritis séptica por Fusobacterium nucleatum en paciente inmunocompetente
Carmen Carrasco Cuberoa,
Corresponding author
maricarmencarrasco@yahoo.es

Corresponding author.
, Priscila Zamora Redb, José Javier Salaberri Maestrojuana, M. Dolores López Prietoc
a Servicio de Reumatología, Hospital de Jerez de la Frontera, Servicio Andaluz de Salud, Cádiz, Spain
b Servicio de Pediatría, Hospital de Jerez de la Frontera, Cádiz, Spain
c Servicio de Microbiología, Hospital de Jerez de la Frontera, Cádiz, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 6-year-old boy was admitted because of pain&#44; swelling and loss of function in his left knee&#44; with an onset 2 weeks prior&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">His past medical history included the repeated bouts of otitis&#44; without other diseases&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Two days before&#44; he had presented fever and abdominal pain&#44; which limited itself&#46; The patient had no other musculoskeletal symptoms or oropharyngeal manifestations&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The physical examination showed clear signs of inflammation in his left knee with flexion limitation but full extension&#46; Arthrocentesis was performed&#44; yielding 15<span class="elsevierStyleHsp" style=""></span>cc of synovial fluid of purulent appearance&#44; and samples were sent to the laboratory for culture&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory tests highlighted a normal leukocyte count&#44; C-reactive protein and elevated erythrocyte sedimentation rate &#40;CRP&#58; 124<span class="elsevierStyleHsp" style=""></span>mg&#47;l and ESR&#58; 30<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#41;&#46; Infectious serology was negative &#40;Brucella&#44; Yersinia&#44; Borrelia&#44; Chlamydia&#44; Campylobacter&#44; parvovirus B19&#41;&#44; as were blood cultures&#44; Mantoux testing and autoimmunity tests &#40;negative ANA&#44; anti-DNA&#44; ANCA&#44; HLA B27&#44; immunoglobulins and RF&#41;&#46; Synovial fluid analysis from the left knee showed signs of inflammation&#44; with 125&#44;200<span class="elsevierStyleHsp" style=""></span>leukocytes&#47;mm<span class="elsevierStyleSup">3</span>&#44; predominance of polymorphonuclear cells &#40;95&#37;&#41;&#44; a glucose of 22<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and elevated proteins &#40;5&#46;9<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The cultures isolated <span class="elsevierStyleItalic">Fusobacterium nucleatum</span>&#44; and there was no antibiotic resistance&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Imaging tests found a diffuse opacity of the right maxillary sinus&#44; with accumulation of secretions inside it and without associated clinical sinusitis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">An ultrasound of the left knee showed moderate synovial effusion and high echogenicity in the posterior recess&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nine days after admission&#44; an MRI was performed which showed a moderate collection in the joint cavity&#44; mainly in the intercondylar notch and showing contrast uptake compatible with synovial proliferation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In the back of the left femoral condyle&#44; we identified a small lytic lesion of approximately 7<span class="elsevierStyleHsp" style=""></span>mm&#215;5<span class="elsevierStyleHsp" style=""></span>mm in diameter&#44; associated with a collection that had peripheral contrast uptake&#44; compatible with small bone inflammation&#46; A CT was performed within 20 days&#44; and a 6-mm lytic lesion was seen in the posterior aspect of the medial femoral condyle&#44; with involvement of the cortical bone without any periosteal reaction observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Septic arthritis of the left knee by <span class="elsevierStyleItalic">Fusobacterium nucleatum</span>&#44; with secondary erosion of the left posterior femoral condyle&#46; Right maxillary sinusitis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Progression</span><p id="par0055" class="elsevierStylePara elsevierViewall">On admission&#44; parenteral antibiotic treatment was begun with cephotaxime and cloxacyllin&#46; After receiving the culture positive for <span class="elsevierStyleItalic">Fusobacterium nucleatum</span>&#44; we started treatment with intravenous metronidazole for 21 days&#46; Given the initial evolution showing marked swelling and flexion deformity of the joint&#44; we decided to perform the arthrotomy with debridement and partial synovectomy with surgical drainage and placement of a continuous lavage system&#44; which was maintained for 5 days&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">After discharge&#44; oral treatment continued for 2 weeks and the patient underwent rehabilitation&#46; The clinical course was favorable&#44; showing no residual deformity or loss of function&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In later visits&#44; a left knee CT and scintigraphy were performed and were normal&#44; with disappearance of the bone erosion&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Septic arthritis caused by anaerobic microorganisms is rare&#46; 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classically associated with Lemierre syndrome&#44; which characteristically presents with thrombophlebitis of the internal jugular vein&#46; Only rarely does it cause septic arthritis&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusobacterium nucleatum</span> septic arthritis in immunocompetent patients is extremely rare&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with few published cases in children&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> Hence&#44; the peculiarity of the case is presented&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In septic arthritis it is important to establish a specific treatment early because of the possibility of rapid joint destruction&#44; which would be accompanied by an irreversible loss of functionality&#46; Treatment involves drainage of the joint along with appropriate antibiotic therapy&#46; Drainage can be accomplished through arthrocentesis&#44; arthroscopy&#44; or through open surgical drainage or arthrotomy&#44; as in this case&#46;</p></span></span>"
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Article information
ISSN: 21735743
Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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