Cortisone
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Reactions 1260 - 11 Jul 2009 S Cortisone Infectious arthritis associated with a popliteal cyst: case report A 54-year-old woman developed infectious arthritis associated with a popliteal cyst, which coincided with an injection of cortisone. The woman had a history of rheumatoid arthritis, treated with etanercept. After complaining of right knee pain and swelling during outpatient hand surgery, she received an injection of cortisone [dosage not stated] using an aseptic technique. One week later, she reported a 1-day history of right knee pain, swelling, tenderness, limited motion and difficulty with weight bearing. No infectious agent was seen on culture or Gram stain. Twenty-four hours later, her symptoms rapidly worsened and she presented to the emergency department. Her knee was swollen, warm and erythematous with limited motion. A large popliteal cyst was also identified. Inflammatory markers were elevated. Knee aspiration fluid was purulent, and a Gram stain showed gram-positive cocci. She was diagnosed with infectious arthritis. The woman underwent arthroscopic irrigation and debridement. Cultures of aspirated knee fluid grew Staphylococcus aureus. Postoperatively, she initiated vancomycin and discontinued etanercept. A week after presenting to the emergency department, she returned with increasing pain, swelling and redness. After recurrent infectious arthritis was identified, she underwent repeat irrigation and debridement. Cultures of purulent fluid again grew S. aureus, this time penicillin-resistant. She was hospitalised and administered vancomycin, with little improvement. The cyst grew and became more painful. The next day, it was excised, and further irrigation and debridement was conducted. Subsequent gram stains and cultures were negative for organisms. After the excision, she improved rapidly, continuing on vancomycin for 6 weeks. At last follow-up, the infection had not recurred. Author comment: "Most cases of pyarthrosis associated with popliteal cyst arise in patients either spontaneously or after cortisone injections. These patients typically also have some level of immune compromise such as rheumatoid arthritis, endocarditis, renal impairment, or other rheumatologic disorders." Eichinger JK, et al. Surgical management of septic arthritis of the knee with a coexistent popliteal cyst. Arthroscopy 25: 696-700, No. 6, Jun 2009 - USA 801146363 1 Reactions 11 Jul 2009 No. 1260 0114-9954/10/1260-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Cortisone
Reactions 1260 - 11 Jul 2009
SCortisone
Infectious arthritis associated with a poplitealcyst: case report
A 54-year-old woman developed infectious arthritisassociated with a popliteal cyst, which coincided with aninjection of cortisone.
The woman had a history of rheumatoid arthritis, treatedwith etanercept. After complaining of right knee pain andswelling during outpatient hand surgery, she received aninjection of cortisone [dosage not stated] using an aseptictechnique. One week later, she reported a 1-day history ofright knee pain, swelling, tenderness, limited motion anddifficulty with weight bearing. No infectious agent was seenon culture or Gram stain. Twenty-four hours later, hersymptoms rapidly worsened and she presented to theemergency department. Her knee was swollen, warm anderythematous with limited motion. A large popliteal cystwas also identified. Inflammatory markers were elevated.Knee aspiration fluid was purulent, and a Gram stainshowed gram-positive cocci. She was diagnosed withinfectious arthritis.
The woman underwent arthroscopic irrigation anddebridement. Cultures of aspirated knee fluid grewStaphylococcus aureus. Postoperatively, she initiatedvancomycin and discontinued etanercept. A week afterpresenting to the emergency department, she returnedwith increasing pain, swelling and redness. After recurrentinfectious arthritis was identified, she underwent repeatirrigation and debridement. Cultures of purulent fluid againgrew S. aureus, this time penicillin-resistant. She washospitalised and administered vancomycin, with littleimprovement. The cyst grew and became more painful. Thenext day, it was excised, and further irrigation anddebridement was conducted. Subsequent gram stains andcultures were negative for organisms. After the excision,she improved rapidly, continuing on vancomycin for6 weeks. At last follow-up, the infection had not recurred.
Author comment: "Most cases of pyarthrosis associatedwith popliteal cyst arise in patients either spontaneously orafter cortisone injections. These patients typically also havesome level of immune compromise such as rheumatoidarthritis, endocarditis, renal impairment, or otherrheumatologic disorders."Eichinger JK, et al. Surgical management of septic arthritis of the knee with acoexistent popliteal cyst. Arthroscopy 25: 696-700, No. 6, Jun 2009 -USA 801146363
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Reactions 11 Jul 2009 No. 12600114-9954/10/1260-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
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