Painful Knee Effusion In A 42 Year Old Male With Hiv - Page #1

Author: Jessica Mofidi, MD
Co Author #1: Marissa Vasquez, MD
Senior Editor: Krystian Bigosinski, MD
Editor: Michael Beasley, MD, FAMSSM

Patient Presentation:
A 42-year-old man with HIV, gout, and recently treated syphilis presented to Sports Medicine Clinic ten days after a left knee injury.

As he lay in bed, he turned his left leg, and felt a snap with sharp pain. Two days later, the knee swelled, and he had difficulty walking. His primary care physician attributed the symptoms to arthritis. Within 2 days, the pain worsened, and the patient went to the Emergency Department (ED). X-rays were done, which showed a suprapatellar effusion but otherwise normal knee, Toradol was given, and he was referred to Sports Medicine. Two days before being seen, the patient also developed gout in his left foot. This resolved with Colchicine. In Sports Medicine Clinic, the patient was using crutches, and could not completely extend his left knee. Swelling had improved, but he had pain around the patella, with occasional locking and instability. He was also having tactile fevers, using hydrocodone/acetaminophen and NSAIDs for pain.

Physical Exam:
Physical examination of the left knee showed a moderate-sized effusion as well as tenderness over the patella, patella tendon, and pes anserinus without erythema. Range of motion was limited to 110 degrees of flexion, with extension to 5 degrees. He had full strength with hip and knee flexion and extension, as well as ankle dorsi and plantar flexion. Patella grind was positive, but the patient had negative ligamentous and meniscal testing. Sensation was intact to light touch.

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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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4000 W. 114th Street, Suite 100
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Phone: 913.327.1415

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