A Review of the Literature on Culture-Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment

PURPOSE: The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI. METHODS: MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded. RESULTS: Seven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes. CONCLUSIONS: In most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI.

Spontaneously Regressed Bilateral Scapulothoracic Bursitis / 대한정형외과학회잡지

Scapulothoracic bursitis causes snapping scapular syndrome, which is characterized by shoulder pain accompanying bony crepitation during shoulder motion, or as an isolated entity causing shoulder discomfort. The pathogenesis of scapulothoracic bursa formation is thought to be related to chronic repetitive mechanical stress on the periscapular tissue, usually from the result of a bone abnormality (a protrusion of the scapula or rib cage). Scapulothracic bursitis is treated with conservative management and the result can be successful. Accurate diagnosis is important because surgery is not necessary except for cases with pain, excessive friction, or dysfunction. We report a patient with rapidly developed bilateral scapulothoracic bursitis without pain and snapping, which can be confused with a soft tissue sarcoma. In this case, conservative management was used to treat the patient.

A Case of Infectious Abdominal Aortic Aneurysm Rupture Due to Staphylococcus aureus Infection in a Hemodialysis Patient / 대한신장학회지

Infectious aneurysms in hemodialysis patients are very rare. It is assumed that injuries on atherosclerotic vessel walls are involved in the development of aneurysms associated with septicemia. Rupture of infectious aneurysms carries a high mortality rate because it often leads to hemorrhagic shock. Here we report the case of a hemodialysis patient with rupture of an abdominal aortic infectious aneurysm secondary to Staphylococcus aureus septicemia. A 72 year-old male hemodialysis patient presented with diarrhea and fever. Staphylococcus aureus was identified in his blood culture. On the sixth day after admission, he developed sudden abdominal pain, distension and hypotension, so we assumed hypovolemic shock due to intraabdominal hemorrhage. On abdominal CT, he was found to have a ruptured, 2.4x2 cm infrarenal abdominal aortic aneurysm with a large amount of retroperitoneal hemorrhage. His final diagnosis was rupture of an infectious aneurysm based on the presence of Staphylococcal bacteremia. He underwent a percutaneous stent graft in the infrarenal aorta successfully. However, two weeks later, he developed septic shock due to a newly developed intestinal perforation and died of multiorgan failure.

A case of concomitant epstein-barr virus-induced hepatitis on chronic autoimmune hepatitis / 대한내과학회지

Autoimmune hepatitis (AIH), a rare cause of chronic liver disease in Korea, is a chronic, predominantly periportal hepatitis characterized by hypergammaglobulinemia, tissue autoantibodies, and responsiveness to immunosuppressive therapy. Here we report a rare case of Epstein-Barr virus (EBV) hepatitis in the presence of a previous diagnosis of AIH. A 25-year-old woman was admitted to the hospital with fever and myalgias. Laboratory data showed elevated aminotransferases, hypergammaglobulinemia, increased anti-nuclear antibody (ANA) titer, positive anti-smooth muscle antibody (ASMA) test, negative anti-mitochondrial antibody (AMA) test, and negative antibody against liver kidney microsome-1 (anti-LKM-1) test. Serologic viral markers of EBV indicated a recent EBV infection. Liver biopsy was performed to search for evidence of accompanying autoimmune liver disease. Liver biopsy findings were consistent with chronic active hepatitis. In-situ hybridization performed on the liver tissue confirmed the presence of EBV DNA. The patient has been treated with prednisolone and has shown subsequent improvement in clinical symptoms and liver function tests.