How much can a small bursa stretch? A curious case of massive superficial infrapatellar bursitis in the emergency department

Ganesh Singh Dharmshaktu,Tanuja Pangtey

doi:10.34172/jept.2021.23

Ganesh Singh Dharmshaktu, Tanuja Pangtey

Open Access

https://doi.org/10.34172/jept.2021.23

Copy DOI

Abstract

Introduction: Inflammation of the infrapatellar bursa results from various causes like trauma, infection and overuse. Superficial skin or soft tissue infection can also lead to occasional septic bursitis. Infrapatellar bursa has two parts, superficial and deep bursae. Superficial bursa inflammation reactive to adjacent superficial skin infection may occasionally lead to secondary bursitis. Case Presentation: We report a rare finding of acute right knee pain with extraordinary amount of fluid collection within superficial part of infrapatellar bursa in an elderly male patient. A secondary, septic and massive superficial infrapatellar bursitis was unusual in its appearance mimicking neoplastic lesion. Judicious use of clinical assessment and imaging helped to diagnose the condition. Conclusion: Early diagnosis and treatment of bursitis can ensure optimal outcome and it can be used to check further complications. Atypical presentation of any bursitis should be acknowledged and the judicious use of clinical assessment and imaging is critical for prompt diagnosis and treatment.

Highlights

Inflammation of the infrapatellar bursa results from various causes like trauma, infection and overuse
Infection directly or adjacent to any bursa can lead to septic bursitis and can present acutely or in chronic recurrent fashion
There was adjacent skin infection that might have resulted in septic bursitis but the signs of infection were not remarkable over the bursa

Summary

Introduction

Infra-patellar bursa, situated adjacent to distal patellar tendon insertion, is one of the many bursae around the knee (1). The ‘clergymen’s knee’ is a colloquial term used to describe its inflammation as the condition is found commonly in priests following frequent kneeling postures. This bursa has superficial and deep parts and the former one lies over the patellar tendon and is commonly involved in bursitis. The swelling was atraumatic, mildly painful, not limiting the knee movement or activities of daily living, minimal to begin with but increasing in size over the week that made him consult a doctor (Figure 1 a-b). The aspiration resulted in 120 mL of non-purulent turbid fluid which was sent for serological tests along with relevant blood tests including hemoglobin, total and differential counts, C-reactive protein and erythrocyte sedimentation rate. Amikacin 500 mg twice a day for a week followed by oral cefuroxime 500 mg twice a day for two weeks led to complete recovery over a period of three weeks with no recurrence in the follow up of nine months

Discussion

Conclusion