The distal femur and the tibial plateau were divided back to macroscopically viable, bleeding bone. ![]() Through an extended anteromedial parapatellar approach a thorough debridement was performed with excision of the entire knee. Staged definite treatment was planned to eradicate the infection while saving the limb. There was relief from pain and the fever subsided. A second debridement and drainage was performed. On examination, there was redness and swelling over her right knee. She became febrile and complained of poorly localised pain throughout the right leg. Ten days post-operatively the symptoms became more severe. Plain radiography and MRI of both knees revealed diffuse osteomyelitis of both tibiae and femora ( Figs 1 and 2). Urine samples were negative for a subclinical Proteus mirabilis infection. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were elevated. She received four intravenous injections of 500 mg Imipenem (Mercu & Co Ltd, Rayway, New Jersey) after the culture-sensitivity results, according to the sensitivity results and remained in hospital. Cultures were obtained, which revealed infection with Proteus mirabilis. Both the abscess cavity and knee were thoroughly debrided and irrigated. As an emergency procedure the abscess was incised and drained it was found to communicate with the adjacent knee. There was an abscess on the anterior aspect of the proximal right tibia. When seen she was walking with a limp, but was afebrile and normotensive. She also took regular antidepressant medication but no other drugs. She had arbitrarily discontinued her antiretroviral medication four months before her first admission to hospital, and, despite medical advice, never resumed this. She had not experienced any clinical manifestations of AIDS and her CD4 count as measured by flow cytometry had been steadily above 500 cells/mm 3 since the initial diagnosis. She had a history of intravenous (IV) drug abuse and two suicide attempts, but to the best of our knowledge had not been using IV drugs for the previous five years. ![]() She had been diagnosed as being HIV-positive nine years earlier. A 43-year-old woman presented with a painful swelling in the anterior aspect of the proximal third of her right tibia.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |