Prepatellar Bursitis with Abscess due to Corynebacterium ulcerans

Corynebacteria are ubiquitous and reside as skin and mucosa commensals in animals. They are considered contaminants in clinical specimens, but significant clinical data points to their virulence and pathogenic potential over the last two decades. Corynebacteria can cause both community-acquired and nosocomial infections. Corynebacterium diphtheriae (C. diphtheriae) responsible for diphtheria has declined over the previous two decades with an increase in a similar clinical syndrome by Corynebacterium ulcerans (C. ulcerans) in Europe. As per recent studies, C. ulcerans shares similar virulence factors with C. diphtheriae. C. ulcerans has been implicated in airway infections, skin and soft tissue infections, lymphadenitis, wound infections, and rarely necrotizing fasciitis. Pet or farm animals have been the source of these infections to humans, as per recent reports. Strains can be either toxigenic or nontoxigenic. Due to recent advances, methods to characterize strains have become easier with mass spectrometry. Antimicrobial susceptibility testing is a must for definite treatment as C. ulcerans can be resistant to first-line antibiotic therapy. If resources are available, it is prudent to find if there is any toxin production. Here, we describe a rural farmer in central Missouri presenting with acute-onset right knee pain diagnosed with right prepatellar bursitis with abscess due to C. ulcerans infection. He recovered with surgical debridement and antimicrobial therapy. This is the first case of C. ulcerans causing prepatellar bursitis with an abscess as per medical literature review.

Glass Removed During Endoscopic Prepatellar Bursectomy

Foreign body objects could be a cause of prepatellar bursitis. This is the only reported case in the literature describing prepatellar bursitis caused by a glass foreign body and the use of endoscopy to retrieve it. During an endoscopic bursectomy to alleviate symptoms of prepatellar bursitis, glass was discovered. The glass was removed and the prepatellar space irrigated and debrided to removed inflamed tissue. This case highlights the only case report of prepatellar bursitis caused by a retained foreign body and the use of endoscopy to remove it. Endoscopic bursectomy is a viable alternative to open bursectomy to minimize wound complications and allow faster recovery.

Pediatric Infectious Prepatellar Bursitis with Kingella kingae

We present the first reported case of septic prepatellar bursitis with Kingella kingae in a 2-year-old female. Although it is a well-established cause of osteoarticular infections in the pediatric population, K. kingae has never been reported as the etiology for septic bursitis. A high index of suspicion is required for the diagnosis given that this organism is difficult to culture and isolate using standard laboratory methods. Our diagnosis was established through bursal fluid analysis, though oropharyngeal polymerase chain reaction (PCR) may be also be considered. Our case also builds upon prior literature suggesting that the pathophysiology of septic bursitis in children differs from that of the adult and may be more comparable to that of pediatric osteomyelitis. As an organism of increasing prevalence, K. kingae should remain high on the differential for osteoarticular or periarticular infections when cultures fail to isolate a distinct pathogen. Early diagnosis and a formal irrigation and debridement, if warranted, are crucial in preventing devastating complications of untreated septic bursitis.

Surgical Management of a Large Chronic Prepatellar Bursitis: 2-Stage Technique

Treatment of a large chronic prepatellar bursitis can be difficult to manage surgically because of a high rate of local complications and a significant chance of recurrence. We present a 2-stage technique using negative pressure dressings which produced a good outcome with no recurrence at one year after surgery.