Bilateral septic arthritis of the knee in a seven-year old sickle cell disease patient: a case report

Abstract

Background: Septic arthritis is an inflammatory process in the joints associated with isolation of pathogens or a positive Gram stain of the synovial fluid. It is a disease condition with significant complications such as joint destruction and immobility. Individual cases are difficult to manage and frequently necessitate prolonged courses of antibiotics.

Aim: The aim of the study was to present our findings with the view towards improving treatment outcomes in similar clinical scenarios.

Findings: Septic arthritis in the index patient developed insidiously and was diagnosed after multiple arthrocentesis were performed. It was bilateral and associated with recurrent bouts of fever, joint tenderness reduced mobility and swelling. The predisposing factor in the index patient, a seven year old male was sickle cell disease. Multiple antimicrobial regimens were instituted in the patient with unsatisfactory results. Initial treatment regimens did not appear to be based on bacteriological statistics which resulted in prolonged hospital stay. Culture of the synovial fluid was initially onto brain heart infusion both and subsequently subcultured onto chocolate and MacConkey agar. The isolate recovered was Serratia rubideae which was identified using the Microbact 12A kit. Susceptibility studies showed the isolate to be susceptible to only meropenem. The patient was subsequently placed on meropenem for forty two days and recovered with radiologic and clinical evidence of improvement and thereafter discharged home.

Conclusion: Close collaboration between the orthopedic surgeon and microbiologist will help to improve treatment outcomes. The Microbact12A kit is recommended in the routine identification of gram negative pathogens.

Keywords: Septic arthritis, sickle cell disease, meropenem, microbact, arthrocentesis, Serratia rubideae