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Septic arthritis caused by Erysipelothrix rhusiopathiae infection after arthroscopically assisted anterior cruciate ligament reconstruction*

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Abstract

A case of septic arthritis caused by Erysipelothrix rhusiopathiae, after an arthroscopically assisted anterior cruciate ligament (ACL) substitution in a non-immunosuppressed patient is described. An 18-year-old man underwent an ACL reconstruction with a quadruple hamstring graft. Eight days postoperatively, the patient developed fever, knee pain, and effusion without erythema or suppuration. He was readmitted to the hospital with the diagnosis of septic arthritis. The patient's erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count were high. The joint was aspirated and the fluid was sent for cultures that revealed the presence of E rhusiopathiae. E rhusiopathiae is widespread in nature, it is transmitted by direct cutaneous laceration, and it causes septic arthritis, meningitis, endocarditis, and renal failure in immunosuppressed people with poor prognosis. In our case, the infection was treated with arthroscopic lavage and debridement, retention of the graft and hardware, and intravenous antibiotic administration for 6 weeks, followed by oral administration for 16 weeks.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp E26

Section snippets

Case report

In September 2000, an 18-year-old male student who had sustained an ACL rupture to his right knee in a soccer game 15 months before, underwent an arthroscopically assisted ACL substitution with a quadruple hamstring graft using the EndoButton technique (Acufex, Smith & Nephew, Mansfield, MA) (Fig 1).

. ACL reconstruction with hamstring graft using the EndoButton technique.

Prophylactic antibiotics (cefuroxime 750 mg every 8 hours and amikacin 500 mg every 12 hours) were used for 48 hours. The

Discussion

E rhusiopathiae is a non–spore-forming facultatively anaerobic gram-positive rod, included in the same group with the genera of Listeria, Lactobacillus, Brochothrix, and Kurthia species.5, 6 It has the microscopic appearance of short rods with rounded ends, occurring singly, in short chains or in long nonbranching filaments. It is nonmotile and grows in complex media at temperatures between 5°C and 42°C and at an alkaline pH. It is catalase and oxidase negative and can grow even in the presence

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*

Address correspondence and reprint requests to P. G. Vallianatos, M.D., 15 Terpsitheas str., 15341, Ag. Paraskevi, Athens, Greece. E-mail: [email protected]

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