Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report

Abstract

Background Brucellosis is an endemic systemic infectious disease, the most common complication is bone and joint involvement. Sacroiliac joint and spinal joint are the most frequently involved sites in adults, but knee joint infection is rare, and acute infectious knee arthritis complicated by acute osteomyelitis is even extremely uncommon in adults. Here, we report two cases of acute septic knee arthritis complicated by acute osteomyelitis caused by Brucella melitensis (B. melitensis). Case presentation Both patients had a history of traveling in animal husbandry areas within three months. On clinical examination, their right knee joint was tender, swollen, had limited movement and an effusion was present. Imaging examination showed effusion and synovial thickening of the right knee joint, as well as subchondral bone edema of the distal femur and proximal tibia. Laboratory examination showed that the serum agglutination test (SAT) in both patients were positive (1: 640 and 1: 320) without leukocytosis, although the proportion of lymphocytes, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) significantly increased. Both patients underwent knee joint aspiration. Real-time polymerase chain reaction (Real-time PCR) analysis of synovial fluid showed that there was B. melitensis, and blood bacterial culture was negative. We determined that two patients had acute brucellosis knee arthritis complicated by acute osteomyelitis. Antibiotic treatment was given during hospitalization consisting of doxycycline (0.1 g po bid) and rifampicin (0.6 g po qd) for six weeks, and the changes of inflammatory indexes were closely monitored. At discharge, the symptoms had completely resolved, imaging abnormalities disappeared, and inflammatory indexes returned to normal. There was no recurrence of the disease at 1-year follow-up. Conclusion Acute brucellosis knee arthritis complicated by acute osteomyelitis is a rare but serious complication of brucellosis in adults. There is no obvious specificity of clinical manifestation and imaging examination. Early diagnosis and treatment can prevent the occurrence of knee joint deformity and even pathological fracture. Clinicians should fully consider the possibility of brucellosis where the travel or occupational history is suggestive.

Increased 18F-FAPI PET/CT Uptake in a Case of Brucellosis of Lumbar Vertebral Body

“…7 Brucellosis is an endemic systemic infectious disease, which frequently appears in pastoral area, and the most common complication is bone and joint involvement. 8 Our case suggests that vertebral brucellosis may be a reason for the increased FAPI uptake, which is similar to malignant lesions or vertebral tuberculosis. It is possible to make a wrong diagnosis and treatment decision.…”

“…However, some previous cases reported intense FAPI uptake on FAPI PET/CT in benign lesions, including tuberculosis, 4 facet joint osteoarthritis, 5 fracture, 6 and SAPHO syndrome 7 . Brucellosis is an endemic systemic infectious disease, which frequently appears in pastoral area, and the most common complication is bone and joint involvement 8 . Our case suggests that vertebral brucellosis may be a reason for the increased FAPI uptake, which is similar to malignant lesions or vertebral tuberculosis.…”

Brucellosis as a Multisystem Disease

“…Arthralgia, enthesopathy, osteomyelitis, arthritis, bursitis, tendonitis, and tenosynovitis (Figures 2 and 3) [24] were all reported. Knee (Figures 4 and 5) [25], hip, and ankle joints are among the most common peripheral regions affected. Shoulders, wrists, elbows, interphalangeal and sternoclavicular joints may also be involved [13].…”

The diagnostic value of blood metagenomic next-generation sequencing in patients with acute hematogenous osteomyelitis

“…Generally, based on the typical clinical manifestation, such as high fever, local tenderness, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, the diagnosis of acute hematogenous osteomyelitis (AHO) is easy to be established (Funk and Copley, 2017). Without rapid etiological diagnosis and proper therapy, AHO may progress to chronic osteomyelitis (Alvares and Mimica, 2020;Wang and Zhang, 2022;Donders et al, 2022) which is difficult to be cured, or may even result in amputation. Therefore, the early diagnosis and treatment of AHO is crucially important for improving the prognoses of patients.…”