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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(S 02): e149-e154
DOI: 10.1055/s-0043-1771487
Relato de Caso

Persistent Knee Monoarthritis as a Lyme Disease Presentation: A Diagnostic Challenge – Case Report

Article in several languages: português | English
Rita Alçada 
1   Serviço de Ortopedia, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
,
Nuno Pina Gonçalves 
2   Hospital Dr. Nélio Mendonça, Funchal, Madeira, Portugal
,
Rita Torres 
3   Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
,
Maria Helena Lourenço 
3   Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
,
Bárbara Flor de Lima 
4   Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
,
Francisco Guerra Pinto 
5   Hospital Ortopédico de Sant'Ana, Parede, Portugal
› Author Affiliations

Financial Support The authors declare that this study received no financial support from public, commercial, or not-for-profit sources.
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Abstract

There are several differential diagnoses for knee monoarthritis. We report a patient with recurrent episodes of knee effusion, in which the non-specific clinical condition implied several diagnostic hypotheses, therapeutic inaccuracies, and a delay in implementing adequate treatment.

For more than 2 years, the patient underwent different Orthopedics and Rheumatology visits. She received multiple therapies, including a knee arthroscopy with partial meniscectomy with transient improvement of the complaints but not a definitive diagnosis. After collecting synovial fluid samples and successively negative microbiological tests, we established the diagnosis of overlap of septic arthritis by atypical microorganisms isolated from synovial tissue (Pantoea spp. and Staphylococcus saprophyticus) and Lyme arthritis. Washing and surgical debridement followed by targeted antibiotic therapy resulted in a transient response due to persistent infection (stage 3).

This case demonstrates the need for a multidisciplinary approach to knee monoarthritis.

Keywords

arthritis, septic - case report - gonalgia - Lyme disease - monoarthritis

Work carried out at the Sant'Ana Orthopedic Hospital, Parede, Portugal.




Publication History

Received: 10 August 2022

Accepted: 27 February 2023

Article published online:
22 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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