An Unusual Klebsiella Septic Bursitis Mimicking a Soft Tissue Tumor

Abstract

Because of its subcutaneous location prepatellar bursitis is frequently complicated by an infection. Gram-positive organisms, primarily Staphylococcus aureus account for the majority of cases of septic bursitis. Local cutaneous trauma can lead to direct inoculation of the bursa with normal skin flora in patients with occupations, such as mechanics, carpenters and farmers. A 71-year-old male was admitted to our department with a history of pain and swelling of his right knee over a 20 year period. Physical examination revealed a swollen, suppurative mass with ulceration of the skin and local erythema which mimicked a soft tissue tumor at first sight. Magnetic resonance imaging of the knee revealed a 13*12*10cm well-circumscribed, septated, capsulated, fluid-filled prepatellar bursa without evidence of tendinous or muscular invasion. The mass was excised en bloc, including the bursa and the overlying skin. The defect was closed with a split thickness skin graft. The patient had 100 degrees flexion and full extension after 45 days postoperatively, and he continued to work as a farmer.

Keywords

• Klebsiella, septic bursitis, haemorrhage, mass

An Unusual Klebsiella Septic Bursitis Mimicking a Soft Tissue Tumor

Öz

ilt altı yerleşiminden dolayı prepatellar bursitlerde enfeksiyon görülmesi sık olur. Gram pozitif mikroorganizmalar, özellikle stafilokokkus aureus en sık etkendir. Tamirciler, halıcılar ve çiftçiler gibi travmaya çok maruz kalan meslek gruplarında direk olarak etken cilt florasından bursaya ulaşabilir. 71 yaşında erkek hasta 20 yılı aşan ağrı ve şişlik nedeni ile kliniğimize başvurdu. Diz üstündeki eritemli,ülseratif ve akıntılı kitle ilk bakışta yumuşak doku tümörüne benziyordu. Manyetik Rezonans incelemede 13*12*10cm boyutlarında iyi sınırlı,septalı,kapsüle sıvı dolu prepatellar bursanın tendinöz veya kas invazyonu yoktu. Kitle üzerindeki cilt ile beraber çıkartıldı ve defekt kısmi kalınlıkta cilt grefti ile kapatıldı. Hastanın 45 gün sonraki kontrolünde 100 derece fleksiyonu ve tam ekstansiyonu vardı ve eski işini yapabiliyordu

Anahtar Kelimeler

• Klebsiella, septik bursit, kanam, kitle

Kaynakça

1. Valeriano-Marcet J, Carter JD, Vasey FB. Soft tissue dis- ease. Rheum Dis Clin N Am 2003;29(1):77-88.
2. Cea-Pereiro JC, Garcia-Meijide J,Mera-Varela A,Gomez- Reino J. A comparison between septic bursitis caused by staphylococcus aureus and those caused by other organ- ism. Clin Rheumatol 2001;20(1):10-4.
3. Zimmerman B 3rd, Mikolich DJ, Ho G Jr. Septic bursitis. Semin Arthritis Rheum 1995;24:391-410.
4. Raddatz DA, Hoffman GS, Franck WA. Septic bursitis. Presentation, treatment and prognosis. J Rheumatol 1987;14(6):1160-3.
5. Canoso JJ, Sheckman PR. Septic subcutaneous bursitis: report of sixteen cases. J Rheumatol 1979;6(1):96–102.
6. Garcia-Porrua C, Gonzalez-Gay MA, Ibanez D, Garcia- Pais MJ. The clinical spectrum of severe septic bursitis in Northwestern Spain: a 10 year study. J Rheumatol 1999; 26(3):663–7.
7. Roschmann RA, Bell CL. Septic bursitis in immunocompro- mised patients. Am J Med 1987;83(4):661–5.
8. Sepkowitz D, Maslow M, Farber M, Seleznick M, Walker R. Cryptococcal bursitis. Ann Intern Med 1988;108(1):154. 50

9. Bower MG. Managing dog, cat, and human bite wounds. Nurse Pract 2001;26(4):36-8.
10. Baldursson BT, Hedblad MA, Beitner H, Lindelof B . Squamous cell carcinoma complicating chronic venous leg ulceration: a study of the histopathology, course and sur- vival in 25 patients. Br J Dermatol 1999;140(6):1148-52.
11. Mello LF, Barcelos MG, Meohas W, et al.Chronic ulceration of the leg following extensive scarring due to a snake bite complicated by squamous cell carcinoma.Skeletal Radiol 2000;29(5):298-301.
12. Phillips TJ, Salman SM, Rogers GS.Nonhealing leg ul- cers: a manifestation of basal cell carcinoma J Am Acad Dermatol 1991;25(1 Pt 1):47-9.