A Rare Case of Septic Arthritis of the Knee Associated with Pathological Neck of Femur Fracture Caused by Serratia Marcescens - A Case Report.

Abstract

Introduction: Septic arthritis is an acute condition of the joints that warrants an emergency procedure of joint arthrotomy with debridement, IV antibiotics postoperatively and commonly affects big joints, which include the hip, knee, and shoulder. Serratia marcescens causing septic arthritis is quite rare and is mainly seen in immunocompromised individuals, and very limited literature is present pertaining to the same.

Case report: A 65-year-old male patient presented to the hospital with sudden inability to bear weight on his right lower limb, inability to flex the knee, which was associated with swelling of the knee, and the limb was externally rotated for 3 days. A fracture of the right neck of the femur was identified on X-ray of the pelvis with bilateral hips. There was no history of trauma. He is a known case of chronic kidney disease for 3 years and is also a known hypertensive and type 2 diabetes mellitus for 15 years, and is currently undergoing dialysis thrice per week. The affected knee was aspirated and was found to have S. marcescens infection, localized there itself; blood culture and intraoperative hip aspirate were negative for the same organism. He underwent right knee arthrotomy with synovectomy and was started on IV antibiotics based on the culture and sensitivity report.

Conclusion: Septic arthritis of the knee joint, along with pathological fracture of the neck of the femur in immunocompromised patients, has to be addressed and given special focus for diagnosis and treatment. Swelling of the knee with inability to flex and acute pain is a sign of septic knee and joint aspiration and antibiotic cover is the mainstay of the treatment, but in cases of acute septic knee, it will require knee arthrotomy with synovectomy and joint debridement.