Medically Managed Lyme Periprosthetic Joint Infection: A Case Report

Abstract

Arthritis associated with Lyme disease is frequent in regions of the United States where the illness is widespread; nonetheless, periprosthetic joint infections (PJI) caused by Lyme are exceptionally rare. As of October 2023, only five cases of Lyme PJI have been documented in the literature. Four of these cases were managed successfully with surgical intervention, while one was managed successfully with oral and IV antibiotics. Because of limited documented cases, there are no recommended treatment guidelines. This has left physicians trying to blend the treatment guidelines for Lyme arthritis, which is medically managed with antibiotics, and PJIs, which involve invasive surgical procedures. The patient in this case presented with a common presentation of acute Lyme arthritis, but it was complicated by a previous total knee arthroplasty. Treatment of this patient included three months of doxycycline 100mg BID, which resulted in complete resolution of symptoms.

Keywords: lyme arthritis; periprosthetic joint infection; pji; tka; total knee arthroplasty.

Figure 1. Left lateral knee x-ray demonstrating total knee arthroplasty with mild joint effusion five days post initial joint aspiration.