BILATERAL KNEE SEPTIC ARTHRITIS IN THREE CHILDREN CAUSED BY UNUSUAL
AGENTS
Hacimustafaoglu M, Celebi S, Sarisozen B, Ildirim I,
Uludag University, Medical Faculty, Bursa, Turkey
Objective: Bilateral septic arthritis in children
is a very rare disease. It is especially reported as case reports in adults
with some underlying (predisposing) factors such as with joint prostheses,
after splenectomy, haemochromatosis, collagen vascular diseases, or hodgkin
lymphoma. We present three children with bilateral septic arthritis of knee
mimicking juvenile rheumatoid arthritis.
Case 1 is a 3.5 months old boy with transposition of
the great arteries and anemia. Synovial fluid with purulent character was
obtained by puncture of both knees. C. albicans was isolated five times
both knees. The patient was improved with fluconazole.
Case 2 is a two years old girl with systemic type
juvenile rheumatoid arthritis (JRA). Knee puncture findings were consistent
with septic arthritis rather than JRA and Gram staining revealed Gram
positive cocci in and out of polymorphonuclear leukocytes. She was improved
rapidly with antibiotics.
Case 3 is a two years and 8 months old girl with
panhypogammaglobulinemia and iron deficiency anemia. Synovial puncture
revealed purulent fluid and cultures revealed Proteus mirabilis (three
times), and she improved with antibiotics. All children had important
underlying predisposing factors (panhypogammaglobulinemia, operated severe
congenital heart disease with prolonged antimicrobial therapy, and systemic
type juvenile rheumatoid arthritis. All children had also anemiae. The
causes were unusual microorganisms such as Proteus mirabilis, and Candida
albicans in two cases.
Conclusion: We concluded that bilateral septic
arthritis should be considered in the differential diagnosis of systemic
type of juvenile rheumatoid arthritis, although it is a rare condition.