Coronavirus Disease 2019 (COVID-19) Can Masquerade as Acute Postoperative Periprosthetic Joint Infection

Eustathios Kenanidis,Panagiotis Kakoulidis,Eleftherios Tsiridis,Panagiotis Anagnostis,Anastasios Beletsiotis

doi:10.7759/cureus.7857

Abstract

Fever etiology during the first postoperative days following total knee arthroplasty (TKA) may be challenging to solve. Early periprosthetic joint infection is the main reason; however, other equally important causes must be excluded such as thrombosis, deep venous thrombosis, and chest or urinary tract infections. We report the case of a 70-year-old Caucasian female patient presented with high fever reaching 39°C, fatigue, and myalgia lasting for a week after a fully cemented primary TKA. Symptoms were falsely attributed to the surgical procedure, leading to erroneous early management and a complicated postoperative course. In the era of the severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) pandemic, a high index of suspicion for coronavirus disease 2019 (COVID-19) symptoms and viral chest infection must be raised, primarily in vulnerable patients.

Highlights

Fever during the first postoperative days following total joint arthroplasty is not uncommon [1]
Important causes must be excluded such as chest or urinary tract bacterial infection, deep venous thrombosis, pulmonary embolic events, and, more rarely, concomitant respiratory viral infections [2]
We report the case of a 70-year-woman who underwent total knee arthroplasty (TKA) a week prior and presented with high fever, myalgia, and malaise

Summary

Introduction

Fever during the first postoperative days following total joint arthroplasty is not uncommon [1]. The clinical examination by a physician at home was focused on the surgical wound and the local hematoma absorption, and she was treated with oral antibiotics (cefuroxime 500 mg twice a day) NSAIDs, paracetamol, hydration, and observation. The patient had persistent periodic high fever up to 38.5°C, myalgia, fatigue, and malaise along with mild coughing. On the tenth postoperative day, the patient turned up in our emergency department exhausted with high temperature up to 38.5°C, seeking orthopedic assistance for a knee infection. She was unable to ambulate, suffering from whole-body myalgia, generic malaise, and persistent cough but no dyspnea.

Discussion

Conclusions

Disclosures