一位49歲女性以反覆性右膝紅腫痛表現

Recurrent Right Knee Inflammation and Pain Experienced by a 49-Year-Old Female

臨床上，右膝紅腫痛，常先入為主被認為是關節炎、痛風或是蜂窩性組織炎。本案例是一位49歲女性患者，反覆性右膝紅腫痛被診斷為蜂窩性組織炎，因右膝疼痛與局部皮膚損傷程度不一致，經電腦斷層和組織切片確診為壞死性筋膜炎，於施行筋膜切開術、反覆性清創及膝上截肢手術後，感染方獲得控制、順利地出院。針對此類以反覆性右膝紅腫痛表現的患者，當抗生素治療效果不彰、臨床表現與疼痛程度不成比例時，必須將壞死性筋膜炎列為鑑別診斷，以免錯失治療先機。

 

In clinical practice, right knee inflammation and pain is frequently considered to be caused by arthri-tis, gout, or cellulitis. In this case, a 49-year-old female patient who experienced recurrent right knee inflammation and pain was initially diagnosed with cellulitis. However, her right knee refractory pain and local skin damage showed conflicting results. A computed tomography scan and biopsy were performed and necrotizing fasciitis was revealed. Fasciotomy, repeated debridement and subsequent above-knee amputation were perfoemed. The infection was eventually controlled and she was then discharged. For patients with recurrent right knee inflammation and refractory pain, when the antibi-otic treatment is not effective and the clinical manifestation mismatches with pain score, necrotizing fasciitis must be considered as a possible differential diagnosis for punctual treatment.