Clinical Images

Knee Drainage Overlying Subcutaneous Calcifications

Authors: Joseph A. Gil, MD and Avi D. Goodman, MD

            An 11-year old female presented to the emergency department with purulent drainage from the inferior aspect of her right knee that developed spontaneously several days prior to presentation. She reported subjective fevers as well as right knee pain that limited her ability to bear weight. Cultures from the infrapatellar bursal drainage were positive for beta-hemolytic Group A Streptococcus. The synovial fluid cultures, initially obtained to rule out septic arthritis, were negative. On admission, intravenous clindamycin was initially administered, which was then transitioned to intravenous cephalexin based on the culture sensitivities. The patient was discharged two days after presentation with ten days of oral cephalexin, with daily dressing changes. The drainage resolved uneventfully with this treatment.

MCQ 1: What is the most likely etiology of the knee drainage?

1. Calcinosis cutis

2. Septic knee

3. Dermatomyositis

4. Lupus erythematosus

5. Calciphylaxis

Click here for multiple choice answer

References:

1.        Reiter N, El-Shabrawi L, Leinweber B, Berghold A, Aberer E. Calcinosis cutis. J Am Acad Dermatol. 2011;65(1):1-12. doi:10.1016/j.jaad.2010.08.038.

2.        Reiter N, El-Shabrawi L, Leinweber B, Berghold A, Aberer E. Calcinosis cutis. J Am Acad Dermatol. 2011;65(1):15-22. doi:10.1016/j.jaad.2010.08.039.

Author Information:

Joseph A. Gil is a Chief Orthopaedic surgery resident at Warren Alpert Medical School of Brown University.

Avi D. Goodman is a PGY3 orthopaedic surgery resident Warren Alpert Medical School of Brown University.