Hematogenous patellar osteomyelitis associated with human immunodeficiency virus.

The case of a 37-year-old man with hematogenous osteomyelitis associated with the human immunodeficiency virus (HIV) is presented, with a review of the literature. Hematogenous osteomyelitis is a relatively rare entity in the patella; most cases have involved adolescents and immunocompromised patients. There have been no previous reports of hematogenous osteomyelitis in HIV-positive patients. The diagnosis requires clinical suspicion and roentgenographic evidence. Point tenderness over the patella and a painful, swollen knee joint are signs that should alert a physician to the possibility of hematogenous osteomyelitis. Laboratory studies are often of little value, and systemic symptoms are often absent. Treatment requires appropriately directed intravenous antibiotics and open drainage and curettage of the patella. Patellectomy may be required for large lesions and in instances of articular involvement. Computed tomography is a helpful diagnostic tool. The patient in this presentation had osteomyelitis of the patella with a knee pyarthrosis. He had open debridement of the extensor mechanism and knee joint, but ultimately required amputation because of repeat pyarthroses.