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Wrestling With Recurrence: Is Doxycycline The Solution? - Page #1
 

Author: Jocelyn Mittner, MD
Co Author #1: Caitlynn Croft, MD
Co Author #2: Christopher Varacallo, DO
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Kevin Chiang, MD, MEd

Patient Presentation:
A healthy 23-year-old male wrestler presented to the sports medicine clinic at the end of his wrestling season for recurrent, atraumatic, right anterior knee pain, with significant swelling and erythema. Prior to presentation to clinic, he was prescribed doxycycline by an urgent care provider for fever in conjunction with the swelling and pain in the knee. The patient reported severe pain with taking wrestling shots and any pressure on the anterior knee. He reported resolution of systemic symptoms, including subjective fevers and chills, after starting treatment with oral doxycycline. Despite antibiotics, icing, rest, and compression, his local symptoms of knee swelling and pain were persistent. He denied numbness, tingling, or weakness in his right leg. He denied wounds on his knee, drainage, or discharge.

History:
Past medical history was significant for one previous episode of septic bursitis of the right prepatellar bursa six months prior. The previous course was managed with aspiration and a course of oral doxycycline. Surgical history was notable for right sided meniscectomy four years prior. Otherwise, his past medical, surgical, social, and vaccination histories were unremarkable.

Physical Exam:
The patient was afebrile and hemodynamically stable. He was well-appearing and in no acute distress. The right knee revealed well-circumscribed, fluctuant, erythematous swelling over the prepatellar bursa that was warm to the touch. The patient had full range of motion of the right knee, although pain was noted at end-range flexion. His strength and neurovascular exams were normal and equal bilaterally. Special tests were completed with negative meniscal testing and no ligamentous instability noted. <a href="CaseStudyImages/CS1WrestlingWithRecu-1394.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a>

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