Intractable pain following core decompression caused by salmonella septic arthritis
Öz
Glucocorticoids (GC), often used in the treatment of diseases caused by autoimmune mechanisms, are the most common nontraumatic causative factor of femoral head avascular necrosis (FHAN). FHAN is, in turn, the most common cause leading to orthopedic surgery in patients using GCs. As GCs suppress the immune system, patients experience increased susceptibility to infections, including FHAN, which has a similar clinical manifestation with septic arthritis. In rare cases, septic arthritis may be caused by salmonella in patients using GCs. Core decompression is the gold standard in the treatment of early stage FHAN.
We report a 28-year-old male patient with multiple
sclerosis (MS) presenting with the complaints of hip pain. The patient had been
treated with two megadoses of steroids. FHAN was considered due to X-ray and
MRI findings. The patient underwent core decompression (CD) and salmonella
bacteria growth was found in the hip puncture culture. Avascular necrosis
associated with septic arthritis was determined. The patient was re-operated
and irrigation and debridement for synovial tissues were performed two days following
the first operation. While the association of septic arthritis with causative Salmonella
and FHAN is rare except in sickle cell patients, septic arthritis must be considered
and ruled out in patients who have previously undergone C
Anahtar Kelimeler
Kaynakça
- 1. Smith SW, Fehring TK, Griffin WL, Beaver WB. Core decompression of the osteonecrotic femoral head. J Bone Joint Surg Am. 1995;77:674-80.
