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BMJ Case Rep. 2010; 2010: bcr0520103041.
Published online Nov 12, 2010. doi:  10.1136/bcr.05.2010.3041
PMCID: PMC3030275
Reminder of important clinical lesson
A hot, swollen joint in a cirrhotic patient
E Omakobia,1 J Hossain,2 J Nash,3 and C Uhuegbu4
1Department of Medicine, William Harvey Hospital, Ashford, UK
2Department of Elderly Care, William Harvey Hospital, Ashford, UK
3Department of Infectious Disease, William Harvey Hospital, Ashford, UK
4Department of Psychiatry, William Harvey Hospital, Ashford, UK
Correspondence to E Omakobia, eugeneomakobia/at/doctors.org.uk
Abstract
Septic arthritis in the elderly carries a high mortality. Underlying risk factors, such as diabetes, malignancy, chronic renal failure, rheumatoid arthritis, hepatobiliary disease and AIDS, should be assessed. Rare causative organisms are occasionally encountered. Here, we describe a case of an 80-year-old diabetic patient with liver cirrhosis who developed Klebsiella pneumoniae septic arthritis, which is a rare cause of joint infection. We postulate that this case supports the notion that the patient's knee effusion seeded during a primary K pneumoniae bacteraemia of intestinal origin and related to liver cirrhosis.
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