BACTERIAL ARTHRITIS IN THE NEUROSURGICAL PATIENT - REPORT ON 4 CASES

BACTERIAL ARTHRITIS THAT occurred in four patients during neurosurgica l convalescence is reported. Three patients had a cerebral aneurysm cl ipped after a subarachnoid hemorrhage, and one had herpes simplex ence phalitis with a possible temporal lobe hemorrhage. All four patients h ad been treated with steroids. A total of six joints were infected, tw o patients with an infection in one joint each, and two with a metachr onous infection in two joints. The interval between the onset of local symptoms and the definitive diagnosis ranged from 0 to 44 days. A del ay in diagnosis severely compromises joint function, and all four of t hese patients were left with an associated significant musculoskeletal disability. Bacterial arthritis is well recognized in the immunocompr omised patient, but, to our knowledge, has not been described in this particular clinical setting. A patient with a sustained pyrexia of unk nown origin in the neurosurgical convalescent period should be suspect ed of having an occult musculoskeletal infection. An isotope bone scan to facilitate early diagnosis is recommended, and this, combined with specific aggressive therapy, should preserve joint function.