多剤耐性淋菌による化膿性膝関節炎の1例

DOI
  • 中野 志保
    東邦大学医療センター佐倉病院 整形外科
  • 赤津 頼一
    東邦大学医療センター佐倉病院 整形外科
  • 中島 新
    東邦大学医療センター佐倉病院 整形外科
  • 園部 正人
    東邦大学医療センター佐倉病院 整形外科
  • 高橋 宏
    東邦大学医療センター佐倉病院 整形外科
  • 齊藤 淳哉
    東邦大学医療センター佐倉病院 整形外科
  • 山田 学
    東邦大学医療センター佐倉病院 整形外科
  • 戸口 郁
    東邦大学医療センター佐倉病院 整形外科
  • 秋山 友紀
    東邦大学医療センター佐倉病院 整形外科
  • 岩井 達則
    東邦大学医療センター佐倉病院 整形外科
  • 柳澤 啓太
    東邦大学医療センター佐倉病院 整形外科
  • 中川 晃一
    東邦大学医療センター佐倉病院 整形外科

書誌事項

タイトル別名
  • A Case Report of Drug-Resistant Gonococcal Knee Arthritis

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<p>Introduction: Staphylococcus aureus and Streptococcus species cause knee arthritis; however, there are very few reports of knee arthritis caused by Neisseria gonorrhea infection. Here, I report a case of purulent knee arthritis caused by multidrug-resistant N. gonorrhea infection.</p><p>Case: A 55-year-old male with diabetes mellitus and a BMI of 25.8 kg/m2 visited our hospital. He complained of pain in his left knee joint and left wrist. His body temperature was 38°C; moreover, he had tenderness, swelling with heat emanating from his left hand joint and left knee joint, and rush on the entire surface of the limbs. He had a diffused inflammatory response along with a white blood cell count of 18520/μL and CRP level of 11.0 mg/dL. Additionally, his blood sugar level was 459 mg/dL and HbA1c level was 10.6%; his diabetes was poorly controlled. We performed a joint puncture after examining left floating patella. The synovial fluid was yellowish white and slightly opaque, with a sugar level of 364 mg/dL and the presence of many white blood cells. However, microscopic examination failed to reveal crystals and bacteria in the synovial fluid. Because we considered the possibility of knee arthritis, we performed arthroscopic debridement. Subsequently, synovial fluid culture was performed, and penicillinase-producing N. gonorrhea (PPNG) was detected on the fifth day. Thus, we initiated intravenous ceftriaxone administration. By postoperative day 17, his inflammatory reaction and symptoms improved.</p><p>Discussion: Reportedly, PPNG accounts for a small percentage of gonococci in Japan. Early arthroscopic debridement, which is recommended for general knee arthritis, proved effective against PPNG.</p><p>Conclusion: We reported a case of knee arthritis caused by multidrug-resistant N. gonorrhea.</p>

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