A 19-year-old farmer presented with acute hepatitis and deep vein thrombosis before being diagnosed as MRSA induced septic knee arthritis

Arab J Gastroenterol. 2021 Feb 4:S1687-1979(20)30119-2. doi: 10.1016/j.ajg.2020.10.002. Online ahead of print.


We introduce this case presented as fever and acute hepatitis in a 19 year old male. Soon after admission, signs of DVT of the left lower limb appeared and was confirmed with Doppler ultrasound. Low molecular weight heparin was introduced in addition to empirical ciprofloxacin and paracetamol given orally in therapeutic doses with no improvement. Then, the attendant physician noticed effusion and tenderness in the left knee, and the diagnosis of septic arthritis was confirmed after ultrasound of the knee and examination by the orthopedic physician. The patient was referred for drainage and wash of the infected left knee. The aspirated fluid was sent for culture and sensitivity that revealed MRSA sensitive to vancomycin and linezolid. Treatment of MRSA along with anticoagulant caused rapid relief of both hepatitis and arthritis and improvement of DVT. The patient returned to normal after finishing courses of antibiotics and anticoagulants. Thus, we'd like to raise the index of suspicion that septic arthritis might induce DVT and hepatic dysfunction in the form of acute hepatitis.

PMID:33551346 | DOI:10.1016/j.ajg.2020.10.002