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A Swollen Knee in a 77-Year-Old Lung Cancer Patient Receiving Antimicrobial Therapy for Pneumonia, Clinical Infectious Diseases, Volume 56, Issue 12, 15 June 2013, Page 1778, https://doi.org/10.1093/cid/cit131
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(See pages 1838–9 for the Answer to the Photo Quiz.)
A 77-year-old man was diagnosed with lung cancer, adenocarcinoma, T2N2M1, stage IV, with multiple bone metastases 2 years previously, and had received erlotinib (150 mg, orally once daily) treatment for 1 year. Three weeks prior to this admission, he had a traffic accident and suffered from bilateral knee abrasion. He was brought to the emergency department with shortness of breath and productive cough for 1 week. Chest radiography revealed bilateral infiltrates. He was intubated and received piperacillin, cefepime, and imipenem/cilastatin subsequently for pneumonia. Progressively swelling left knee with local heat occurred 3 weeks after admission (Figure 1A). Arthrocentesis revealed milky fluid containing 69 300 white blood cells/mL with 93% polymorphonuclear cells. Stains and cultures for bacteria and mycobacteria revealed negative results. Empiric vancomycin was prescribed. However, the swollen knee exacerbated in the following 2 weeks. Culture of the repeated arthrocentesis material and blood specimens both grew whitish, downy, cottony colonies on blood and chocolate agar plates (Figure 1B). Four days later, microorganisms grew on potato dextrose agar; the microscopic features are shown in Figure 2.
