Abstract
It is rare for acalculous cholecystitis to present with symptoms outside the abdomen; hence, making its diagnosis can be a challenge. We report a case of a 77-year-old male, with a relevant past medical history of left knee arthroplasty two years prior, who presented with left knee pain and swelling. Cultures from the arthrocentesis grew Clostridium perfringens, which led to a search for the source of infection. The right upper quadrant (RUQ) ultrasound (US) showed an enlarged gallbladder filled with sludge, but no cholelithiasis or secondary ultrasound findings were present to suggest acute cholecystitis. A computed tomography (CT) scan showed a distended gallbladder with diffuse gallbladder wall thickening and no stone but with suspicion for acalculous cholecystitis. A subsequent hepatobiliary (HIDA) scan confirmed the diagnosis of acalculous cholecystitis. Subsequently, the patient had a biliary drain placed. Bile cultures grew gram-positive rods consistent with Clostridium perfringens, confirming the source. With regards to the septic prosthetic joint, the patient underwent irrigation and debridement with polyethylene exchange without replacement of the prosthesis. The patient was also treated with six weeks of intravenous (IV) ertapenem (1 gram daily) and 12 months of moxifloxacin (400 mg daily). He had a cholecystectomy later and his symptoms were completely resolved.
Highlights
Prosthetic joint infection (PJI) is a serious complication that occurs in 1% to 2% of total knee arthroplasties [1]
It is challenging in such a clinical scenario to identify the source of infection and how to treat such PJI, as no guidelines exist to date
Penicillin was reportedly effective in the previous cases, but our patient was effectively treated with IV ertapenem 1 gram daily for six weeks and moxifloxacin 400 mg daily for 12 months, given his penicillin allergy
Summary
Prosthetic joint infection (PJI) is a serious complication that occurs in 1% to 2% of total knee arthroplasties [1]. At the time of admission, the patient had a temperature of 102°F with a blood pressure of 100/75 mmHg and pulse of 87/minute and was maintaining 97% saturation on pulse oximetry on room air Upon examination, he had diffuse swelling, erythema, and tenderness of the left knee. The gram stain of the synovial fluid reported gram-positive rods, which were later confirmed to be Clostridium perfringens on cultures. Even though the patient denied abdominal pain, nausea, vomiting, or diarrhea, given the rare incidence of a Clostridium perfringens prosthetic joint infection, a gastrointestinal source was suspected given his history of sigmoid colon DLBCL. The patient’s symptoms resolved completely, and at his six-month follow-up visit, he did not have any symptoms or signs suggestive of infection in the left knee prosthetic joint, and he was able to ambulate without any limitations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
