A rare case of septic arthritis of hip due to perforated appendicitis

Written By : Dr.Niharika Harsha B |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-09-09T18:00:32+05:30 | Updated On 9 Sept 2020 6:00 PM IST

Mahnoor Zia and Nima Maghami from Texas A&M College of Medicine reported a rare complication of septic arthritis of hip which occurred due to perforation of the appendix. The case was published in the journal, International Journal of Surgery Case Reports, 2020.

Appendiceal perforation is a progressive inflammation in acute appendicitis which can lead to appendiceal perforation and complicated appendicitis. Complicated appendicitis is associated with high morbidity and mortality. Untimely management can lead to seeding of infection and further complications.

According to history presented in this unique case, a 32-year-old male with a medical history of perforated appendicitis 18-days before the presentation was admitted to the hospital with a 4-day history of worsening right hip pain. There was moderate tenderness to palpation on the right lateral hip and restricted range of motion. Blood work showed elevated inflammatory markers.

The patient was started on IV vancomycin and cefepime and later changed to ertapenem as per the guidelines. Computed tomography (CT) with contrast was remarkable for right hip joint effusion with multiple enlarged right pelvic wall lymph nodes.Arthrocentesis of the right hip yielded cloudy serous fluid. The synovial fluid analysis revealed leukocytosis (84.8 k/CMM) with neutrophilia (89%) without any evidence of crystals. Bacterial and fungal cultures were negative.

Also Read:Rare case of Gastrointestinal Myeloid Sarcoma reported in NEJM

Past medical history of the patient revealed acute onset abdominal pain and elevated inflammatory serum markers. CT abdomen and pelvis were taken which revealed peri-appendiceal abscess. As abscess was small, medical management with IV antibiotics was done. But as the appendix was diffusely inflamed on repeat CT, an interval appendectomy was planned 4 weeks post-discharge.

But in the meanwhile patient developed an inflammatory arthropathy in the right hip for which he underwent an open arthrotomy with incision and drainage of the right hip abscess. MRI of the hip on post-op 3rd day revealed resolution of the periarticular abscess. Later laparoscopic appendectomy was also performed for the perforated appendix.

For further reference, click the following link: https://doi.org/10.1016/j.ijscr.2020.05.09

septic arthritisperforated appendixarthrocentesisarthropathyappendicitiscomplicated appendicitis

Source : International Journal of Surgery Case Reports

Dr.Niharika Harsha B

BDS, MDS

Dr.Niharika Harsha B (BDS,MDS) completed her BDS from Govt Dental College, Hyderabad and MDS from Dr.NTR University of health sciences(Now Kaloji Rao University). She has 4 years of private dental practice and worked for 2 years as Consultant Oral Radiologist at a Dental Imaging Centre in Hyderabad. She worked as Research Assistant and scientific writer in the development of Oral Anti cancer screening device with her seniors. She has a deep intriguing wish in writing highly engaging, captivating and informative medical content for a wider audience. She can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751