Pseudo-septic arthritis developed after hyaluronic acid injection: A case report

Abstract

One of the most frequent causes of knee pain is knee osteoarthritis. Intra-articular hyaluronic acid (HA) injection is one of the preferred treatment methods. Although, systemic side effects are not seen, rarely local side effects as pain and swelling can be seen. Following HA injection, some cases with pseudo-septic manifestations unrelated to crystal formation have been reported. In this case report, a patient with knee pain which aggravated with medial tibio-femoral osteoarthritis refractory to conservative treatment methods including administration of non-steroidal anti-inflammatory drugs and others is presented. After intra-articular HA injection, her preexisting knee pain worsened, and swelling, and increase in local temperature were added to the clinical picture. Based on clinical, and laboratory examinations, and analysis of synovial fluid, diagnosis of pseudo- septic arthritis which mimicked manifestations of septic arthritis was made. Clinical, and laboratory improvement was achieved with early treatment. If following intra-articular HA injection, knee pain of the patient aggravates suddenly with local swelling and heat, then the possibility of pseudoseptic arthritis of the affected knee should be always kept in mind.

Keywords

• Knee,Pseudoseptic arthritis,Hyaluronic acid,Knee osteoarthritis

Hylarunoik asid enjeksiyonu sonrası gelişen psödo-septik artrit: Olgu sunumu

Öz

Diz ağrısının en sık nedenlerinden biri diz osteoartritidir. İntraartiküler hyaluronik asit (HA) enjeksiyonları sık tercih edilen tedavi yöntemlerinden biridir. HA enjeksiyonlarından sonra sistemik yan etkiler neredeyse hiç görülmemekle birlikte, seyrek olarak ağrı ve şişlik gibi lokal yan etkiler görülebilmektedir. HA enjeksiyonu sonrası, kristal oluşumuna bağlı olmayan pseudoseptik artrit tablosu literatürde çok az sayıda olguda bildirilmiştir. Bu olguda medial tibia-femoral osteoartrite bağlı yürümekle şiddetlenen, nonsteroidal antiinflamatuar ve diğer konservatif tedavi yöntemlerine yanıtsız diz ağrısı olan ve intraartiküler HA enjeksiyonu uygulandıktan sonra dizinde mevcut olan ağrının artması, şişlik ve ısı artışı eklenmesi nedeniyle yapılan klinik muayene, laboratuvar tetkikleri ve sinoviyal sıvı analizi sonucu hastaya septik artrit tablosunu taklit eden psödoseptik artrit tanısı kondu. Erken tedavi ile klinik ve laboratuvar iyileşme sağlandı. Dize intraartiküler HA enjeksiyonu sonrası bir hastada aniden diz ağrısında artma, şişlik ve ısı artışı olursa, etkilenen eklemde psödoseptik artrit olasılığı her zaman akılda tutulmalıdır.

Anahtar Kelimeler

• Diz,Psödoseptik artrit,Hyaluronik asit,Diz osteoartrit

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