Salih BEYAZ, Bekir Murat ÇİNAR, Ümit Özgür GÜLER, Filiz AKA BOLAT

Intractable pain following core decompression caused by salmonella septic arthritis

Glikokortikoidler (GK) otomimmün hastalıkların tedavilerinde sıklıkla kullanılmaktadırlar ve femur başı avasküler nekrozunun (FBAN) bilinen en sık travmatik olmayan sebebidirler. GK kullanan hastalardaki en sık ortopedik cerrahi nedeni ise FBAN'dur. GK'ler immün sistemi baskılayarak enfeksiyona yatkınlığı artırır. FBAN septik artrit ile benzer klinik tabloya sahiptir. GK kullanan hastalarda Salmonella nadir bir septik artrit sebebidir. Erken evre FBAN tedavisinde kordekompresyon altın standart tedavi yöntemidir. Hastamız 28 yaşında erkek ve kliniğimize kalça ağrısı şikayeti ile başvurdu. Öyküsünden Multipl Skleroz tanısı (MS) sebebiyle iki kere megadoz steroid tedavisi gördüğünü öğrendik. Röntgen ve MRI bulguları FBAN'u destekler nitelikteydi. Hastaya kordekompresyon operasyonu uyguladık ve eklem sıvısından örnek aldık. Operasyondan sonra alının örnekte Salmonella bakterisi üremesi üzerine FBAN'nun septik artrit ile birlikte olduğunu anladık. Hastayı ilk operasyonunundan 2 gün sonra tekrar opere ederek sinoviyal dokulara yönelik debridman ve yıkama işlemi uyguladık. Salmonella septik artriti ile FBAN birlikteliği orak hücreli anemisi olan hastalarda bildirilmesine rağmen nadirdir. Erken evre FBAN sebebiyle kordekompresyon uygulanan ve beklenen klinik iyileşme görülmeyen hastalarda septik artrit ekarte edilmelidir

Salmonella septik artritinin yol açtığı kor-dekompresyon sonrası geçmeyen ağrı

Glucocorticoids (GC), often used in the treatment of diseases caused by autoimmune mechanisms, are the most common nontraumatic causative factor of femoral head avascular necrosis (FHAN). FHAN is, in turn, the most common cause leading to orthopedic surgery in patients using GCs. As GCs suppress the immune system, patients experience increased susceptibility to infections, including FHAN, which has a similar clinical manifestation with septic arthritis. In rare cases, septic arthritis may be caused by salmonella in patients using GCs. Core decompression is the gold standard in the treatment of early stage FHAN. We report a 28-year-old male patient with multiple sclerosis (MS) presenting with the complaints of hip pain. The patient had been treated with two megadoses of steroids. FHAN was considered due to X-ray and MRI findings. The patient underwent core decompression (CD) and salmonella bacteria growth was found in the hip puncture culture. Avascular necrosis associated with septic arthritis was determined. The patient was re-operated and irrigation and debridement for synovial tissues were performed two days following the first operation. While the association of septic arthritis with causative Salmonella and FHAN is rare except in sickle cell patients, septic arthritis must be considered and ruled out in patients who have previously undergone CD and did not show expected relief in early stage FHAN

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