A 76-year-old woman with a history of ischemic heart disease, diagnosed with seronegative rheumatoid arthritis in 1992 due to chronic, symmetrical and erosive polyarthritis who met five of the American College of Rheumatology criteria.
The background medication used was chloroquine and parenteral methotrexate.
In 2000, he underwent a right total knee arthroplasty with satisfactory results.
In 2002, she developed normocytic anemia, fatigability, sensory-motor peripheral neuropathy and stenosis.
Hematological study revealed a monoclonal IgM component of 3.1 g/dl and after a bone marrow biopsy, Waldenström macroglobulinemia was diagnosed.
Because the patient remained stable and oligosymptomatic with low doses of prednisone (7.5 mg/day) and oral methotrexate (week), the nucleating attitude of different agents was maintained, as she chose to maintain a relaxed attitude.
During the first three days of August 2005 he had a self-limiting febrile diarrhea.
After a one-week improvement, the patient began with fever, pain, swelling and progressive limitation of mobility in the right knee, symptoms pertaining to August that prompted consultation and admission to our center on August 25.
Examination revealed an axillary temperature of 37.5 oC, swelling and tension effusion in the right knee, patchy hypoesthesia in the lower limbs, and abolition of the ankle reflexes.
Arthrocentesis gave rise to a creamy purulent fluid with 75,000 leukocytes/mm3 (> 95% polymorphonuclear).
Gram stain did not allow the visualization of microorganisms, but aerobic cultures revealed sensitivity to penicillin, ampicillin, cotrimoxazole and rifampicin.
The ESR was 120 mm/1 hour.
C-reactive protein: 5dl IgM/L. Blood count showed 6.5 x 109 leukocytes/L (47% neutrophils, 25% lymphocytes, 14% monocytes), Hb: 99 g/L, hematocrit: 28.7 L/L, platelets:
The following parameters were normal or negative: biochemistry (serum, creatinine, urea, total, triglycerides, lactic dehydrogenase, lactic dehydrogenase, urinary phosphodiesterase, sodium, cholesterol, alkaline phosphatase)
Rheumatoid factor by latex was 54 IU/ml.
The chest X-ray showed no abnormalities.
Radiography of the right knee revealed periprosthetic radiographs.
Abdominal ultrasound showed signs of hepatic steatosis and mild stenosis.
In addition to drainage and lavage of the joint with saline solution, 2 g of ampicillin were administered intravenously every 6 h and gentamicin (3 mg/kg/8 h; maintaining a concentration between 4 and 9 mg/ml)
At the time of writing this clinical note three months have passed since hospital discharge, the patient progresses favorably and receives treatment with cotrimoxazole and rifampicin, which will last up to a total of 6 months.
