Case report: subacute synovitis of the knee after a rose thorn injury: unusual clinical picture.
Synovitis secondary to penetrating plant thorn injuries is not frequently reported. Historically, it is considered aseptic and treated with removal of the intraarticular foreign body and affected synovial lining. We report a 57-year-old healthy man who was admitted 2 weeks after being injured by a rose (Rosacea) thorn with subacute and mild synovitis with effusion of his right knee. No intraarticular foreign body was retained. Pantoea agglomerans was identified in the synovial fluid. Contrary to former teaching, effusions from joints violated by thorns should not be presumed sterile. Bacterial growth is reported infrequently, but when reported, Pantoea agglomerans is the most common organism found. We recommend removal of foreign bodies if present, arthroscopic total synovectomy, and beginning empiric antibiotic treatment with coverage against gram-negative enteric pathogens in all cases of thorn synovitis until the results of culture specimens are known. Improved physician awareness can result in more rapid diagnosis and improved clinical outcome in affected individuals.
Duerinckx
Joris F H
JF
Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. joris.duerinckx@gmail.com
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007718:Knee Injuries / Q000150:complications / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D020636:Pantoea; D010406:Penicillins / Q000627:therapeutic use; D018515:Plant Leaves / Q000382:microbiology*; D027826:Rosa; D013582:Synovial Fluid / Q000382:microbiology*; D013585:Synovitis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D014950:Wounds, Penetrating
D000900:Anti-Bacterial Agents; D010406:Penicillins; C031367:temocillin
Br Med J (Clin Res Ed). 1981 Jan 31;282(6261):361-2
6780024
Clin Orthop Relat Res. 1993 Feb;(287):233-6
8448949
Arthritis Rheum. 1977 Jun;20(5):1125-8
869959
J Clin Microbiol. 2007 Jun;45(6):1989-92
17442803
J Bone Joint Surg Br. 1990 May;72(3):512-3
2341459
Arthroscopy. 1991;7(2):244-5
2069639
Arch Intern Med. 1978 May;138(5):788
646543
Int J Antimicrob Agents. 2001 Jul;18(1):81-3
11463532
Arthritis Rheum. 1977 Jul-Aug;20(6):1206-12
20111
J Comput Assist Tomogr. 1985 Nov-Dec;9(6):1135-6
4056154
Arthroscopy. 2001 Nov-Dec;17(9):993-6
11694934
J Bone Joint Surg Br. 1990 May;72(3):514-5
2341460
Radiology. 1953 Apr;60(4):592-5
13038058
J Rheumatol. 1990 Feb;17(2):252-4
2181130
Arthroscopy. 2004 Oct;20(8):865-8
15483550
Arthroscopy. 2002 Feb;18(2):E7
11830822
Semin Arthritis Rheum. 1991 Aug;21(1):40-6
1948100
Clin Rheumatol. 2007 May;26(5):849-51
17273812
J Rheumatol. 1980 Jul-Aug;7(4):567-9
7420341
Arthroscopy. 2001 Jan;17(1):77-80
11154373
Pediatr Infect Dis J. 2004 Jul;23(7):690
15247618
Arch Dis Child. 2003 Jun;88(6):542-4
12765929
Br Med J (Clin Res Ed). 1982 Dec 4;285(6355):1620
6814678
Clin Rheumatol. 2000;19(6):490-1
11147764
Acta Orthop Scand. 1985 Aug;56(4):342-3
3907263
J Pediatr Orthop. 1984 Mar;4(2):175-9
6699159
J Clin Microbiol. 2000 Jan;38(1):460-1
10618144
Biosci Biotechnol Biochem. 2002 Nov;66(11):2474-8
12506991
J Bone Joint Surg Br. 1966 Aug;48(3):474-7
5913137
Skeletal Radiol. 2000 Oct;29(10):605-8
11127686
Appl Environ Microbiol. 2003 Feb;69(2):1220-8
12571050