RESUMEN
BACKGROUND: In adults, Baker's cyst development is attributable principally to secondary alterations after degenerative changes. The latter changes often accompany osteoarthritis, and we frequently encounter patients with Baker's cysts seeking total knee arthroplasty (TKA). Baker's cysts are not usually subject to extensive preoperative evaluation because the cysts often disappear naturally after surgery, unaccompanied by any adverse symptoms. CASE PRESENTATION: A 63-year-old woman presented with moderate pain in the left knee joint that had developed 1 year ago. Posterior knee pain was aggravated on maximum knee flexion. Three months previously, a popliteal mass had become palpable and the patient had undergone needle mass aspiration twice in a local orthopedic hospital, but the mass had recurred. We initially considered TKA for her severe degenerative osteoarthritis. However, we decided to perform only arthroscopic debridement and cyst excision because the patient was experienced severe pain only on maximal knee flexion, and did not want TKA. Pus gushed from the torn cyst during the operation. We diagnosed an infected Baker's cyst. The patient was treated with a first-generation cephalosporin postoperatively. CONCLUSIONS: A Baker's cyst that was aspirated and still causes symptoms with altered blood tests needs to be evaluated accurately before TKA.
Asunto(s)
Artralgia/diagnóstico , Artroscopía , Cefalosporinas/uso terapéutico , Osteoartritis de la Rodilla/cirugía , Quiste Poplíteo/diagnóstico , Artralgia/etiología , Artralgia/terapia , Artroplastia de Reemplazo de Rodilla/efectos adversos , Desbridamiento/métodos , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Dimensión del Dolor , Quiste Poplíteo/complicaciones , Quiste Poplíteo/microbiología , Quiste Poplíteo/terapia , Cuidados Preoperatorios/métodos , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/prevención & control , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Patients with psoriatic arthritis (PsA) are at increased risk of infection due to disease course or treatment-related immunodeficiency. We describe a patient with a 10-year history of PsA, with arthritis of the right knee and pain and edema in the right calf, treated with the TNFa inhibitor etanercept for 6 months. Ultrasound showed accumulation of hypoechoic fluid, which was aspirated and was positive for staphylococcus and aspergillus. The patient recovered after surgical drainage and four weeks of antibiotic and antifungal therapy.
Asunto(s)
Antirreumáticos/efectos adversos , Artritis Psoriásica/tratamiento farmacológico , Etanercept/efectos adversos , Quiste Poplíteo/inducido químicamente , Adulto , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Artritis Psoriásica/complicaciones , Aspergilosis/tratamiento farmacológico , Aspergilosis/etiología , Aspergillus , Humanos , Masculino , Quiste Poplíteo/tratamiento farmacológico , Quiste Poplíteo/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/etiología , Staphylococcus , Resultado del TratamientoAsunto(s)
Anticuerpos Antinucleares , Enfermedad de Lyme , Quiste Poplíteo , Adolescente , Anticuerpos Antinucleares/sangre , Anticuerpos Antinucleares/inmunología , Humanos , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/inmunología , Enfermedad de Lyme/microbiología , Masculino , Quiste Poplíteo/diagnóstico , Quiste Poplíteo/inmunología , Quiste Poplíteo/microbiologíaAsunto(s)
Quiste Poplíteo/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Quiste Poplíteo/complicaciones , Quiste Poplíteo/diagnóstico por imagen , Quiste Poplíteo/microbiología , Rotura Espontánea , Infecciones Estafilocócicas/complicaciones , Tromboembolia/diagnóstico , Ultrasonografía , Trombosis de la Vena/diagnóstico por imagenRESUMEN
We report a case of knee pyarthrosis in a 54-year-old woman with rheumatoid arthritis and a popliteal cyst. The onset of infection coincided with a cortisone injection. Initial management consisted of arthroscopic irrigation and debridement (I&D) on 2 consecutive occasions without resolution of the infection. Only after open excision of the popliteal cyst in conjunction with I&D of the knee joint proper did the infection resolve. This is the first reported case of a patient requiring excision of a popliteal cyst to clear pyarthrosis of the knee after failure of arthroscopic I&D. Consideration should be given to open debridement or drainage of popliteal cysts in patients who present with septic arthritis in the presence of a popliteal cyst. A treatment algorithm for managing this clinical scenario is presented.
Asunto(s)
Artritis Infecciosa/cirugía , Artritis Reumatoide/complicaciones , Artroscopía/métodos , Quiste Poplíteo/cirugía , Infecciones Estafilocócicas/cirugía , Algoritmos , Antibacterianos/uso terapéutico , Artritis Infecciosa/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Terapia Combinada , Desbridamiento , Drenaje , Femenino , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Inyecciones Intraarticulares/efectos adversos , Persona de Mediana Edad , Quiste Poplíteo/complicaciones , Quiste Poplíteo/microbiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológico , Trastorno del Dedo en Gatillo/complicaciones , Trastorno del Dedo en Gatillo/cirugíaRESUMEN
Lyme disease is the most common tick-borne disease in North America. Our review of the literature found few reports of Lyme disease presented in the orthopaedic literature. However, Lyme disease presenting as a popliteal cyst, with or without rupture, is rarely reported. We present 4 cases of Lyme disease that initially presented to our pediatric orthopaedic clinic for treatment of a popliteal cyst. The early diagnosis and treatment of Lyme disease may help prevent the often-devastating long-term sequelae of Lyme disease. The goal of this article is to increase the awareness of Lyme disease presenting in children as a popliteal cyst.
Asunto(s)
Enfermedad de Lyme/complicaciones , Quiste Poplíteo/etiología , Adolescente , Anticuerpos Antibacterianos/análisis , Western Blotting , Borrelia burgdorferi/inmunología , Niño , Diagnóstico Diferencial , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/microbiología , Imagen por Resonancia Magnética , Masculino , Quiste Poplíteo/diagnóstico , Quiste Poplíteo/microbiología , Pronóstico , Estudios RetrospectivosAsunto(s)
Artritis Psoriásica/complicaciones , Quiste Poplíteo/complicaciones , Sepsis/microbiología , Infecciones Estafilocócicas/diagnóstico , Staphylococcus epidermidis/aislamiento & purificación , Anciano , Humanos , Traumatismos de la Rodilla/complicaciones , Masculino , Quiste Poplíteo/microbiología , Quiste Poplíteo/terapia , Rotura , Sepsis/terapia , Infecciones Estafilocócicas/terapiaAsunto(s)
Articulación de la Rodilla/microbiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Miositis/microbiología , Micobacterias no Tuberculosas/aislamiento & purificación , Quiste Poplíteo/diagnóstico , Azitromicina/uso terapéutico , Claritromicina/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Quiste Poplíteo/microbiología , Rifampin/uso terapéuticoAsunto(s)
Quiste Poplíteo/complicaciones , Infecciones Estafilocócicas/complicaciones , Humanos , Articulación de la Rodilla/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Penicilina G/uso terapéutico , Quiste Poplíteo/tratamiento farmacológico , Quiste Poplíteo/microbiología , Quiste Poplíteo/patología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/patología , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
This case illustrates the importance of expanding the differential diagnosis beyond ruling out a DVT in a patient presenting with calf swelling. A good history and examination and a compulsive search for an etiology are necessary in the pursuit of the correct diagnosis. In this patient, only after identifying the popliteal cyst and recognizing that it represented an inflammatory synovitis could the cause be determined and the proper treatment instituted.
Asunto(s)
Edema/etiología , Pierna , Enfermedad de Lyme/complicaciones , Quiste Poplíteo , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Doxiciclina/uso terapéutico , Femenino , Humanos , Pierna/diagnóstico por imagen , Enfermedad de Lyme/tratamiento farmacológico , Persona de Mediana Edad , Quiste Poplíteo/diagnóstico por imagen , Quiste Poplíteo/tratamiento farmacológico , Quiste Poplíteo/microbiología , Tromboflebitis/diagnóstico , UltrasonografíaRESUMEN
After the spine, the knee joint is the most commonly affected joint in skeletal tuberculosis. Baker's cyst is a rather rare complication of knee joint tuberculosis. The plain radiographic appearance of the tuberculous knee joint has been amply described. We present the magnetic resonance appearance of a tuberculous knee joint associated with a ruptured popliteal cyst.
Asunto(s)
Articulación de la Rodilla/patología , Imagen por Resonancia Magnética , Quiste Poplíteo/diagnóstico , Tuberculosis Osteoarticular/diagnóstico , Biopsia con Aguja , Femenino , Humanos , Articulación de la Rodilla/microbiología , Persona de Mediana Edad , Músculo Esquelético/microbiología , Músculo Esquelético/patología , Mycobacterium tuberculosis/aislamiento & purificación , Quiste Poplíteo/etiología , Quiste Poplíteo/microbiología , Rotura Espontánea , Tuberculosis Osteoarticular/complicaciones , Tuberculosis Osteoarticular/microbiologíaRESUMEN
A Baker cyst (synovial cyst) in the right knee-joint was demonstrated by ultrasound in a 70-year-old woman with recurrent knee-joint effusions after minimal trauma to the knee. Radiological examination in two planes showed degenerative changes corresponding to age. Needle puncture of the knee-joint demonstrated numerous neutrophil granulocytes. As the effusion recurred after one week, despite rest and avoidance of weight bearing, arthroscopy with removal of the cyst was indicated. But surprisingly histological examination of synovial tissue revealed epithelioid granulomas and Langerhans giant cells. Culture of fluid obtained on repeat puncture finally grew Mycobacterium tuberculosis. There was no evidence of pulmonary tuberculosis. The knee-joint tuberculosis healed completely without residual damage on antituberculosis treatment, initially 600 mg rifampicin daily, 300 mg isoniazid daily and 2.5 g pyrazinamide daily for 3 months, followed by rifampicin and isoniazid for a further 6 months.
Asunto(s)
Articulación de la Rodilla , Quiste Poplíteo/etiología , Tuberculosis Osteoarticular/complicaciones , Anciano , Biopsia con Aguja , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/microbiología , Articulación de la Rodilla/patología , Mycobacterium tuberculosis/aislamiento & purificación , Quiste Poplíteo/diagnóstico , Quiste Poplíteo/microbiología , Quiste Poplíteo/patología , Radiografía , Recurrencia , Líquido Sinovial/microbiología , Membrana Sinovial/patología , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/microbiología , Tuberculosis Osteoarticular/patología , UltrasonografíaRESUMEN
Candida species are an uncommon cause of infectious arthritis, although the frequency has increased during recent years. Three cases of septic arthritis caused by Candida species are reported, and the literature is reviewed. The first patient developed a popliteal cyst infected by Candida albicans after multiple intravenous antibiotic treatments. The second patient had acute myelogenous leukemia and experienced knee arthritis after chemotherapy, and the third suffered oligoarthritis after a second heart transplantation. All patients received treatment with a standard dose of intravenous amphotericin B. Responses were achieved only in the first two cases; the third patient died despite therapy. Thirty-six previously reported Candida arthritis cases are reviewed, and epidemiologic, diagnostic, therapeutic, and prognostic features are analyzed. Cases are divided into two categories: direct inoculation of fungus and hematogenously disseminated disease; these two categories are compared in terms of sex, age, pathogen species, treatment, and survival. Arthritis induced through direct inoculation of fungus is seen in older individuals, is more frequently produced by species other than C albicans (Candida parapsilosis especially), and has a better prognosis than arthritis caused by disseminated candidiasis. Arthritis can be resolved even in the persistence of the systemic disease. It is believed that the first case of Baker's cyst infected by C albicans and the first case of Candida arthritis in a heart transplant patient are reported here.