1 case report:misdiagnosis of hemophilic knee arthropathy

XIANG Chuan; HU Yan-hui; WANG Zi-jiang; LUO Run-ming; WEI Xiao-chun

doi:10.3969/j.issn.2095-252X.2013.08.009

Abstract： Objective To report a case of hemophilic arthritis misdiagnosed for 35 years, and to provide clinicians with experience and lessons for reference. Methods The patient was from the Department of Orthopedics of the 2nd Affiliated Hospital of Shanxi Medical University, who had the disease at the age of 7. Definite diagnosis has not been made even though the patient had been seeking medical advice from county, district and provincial hospitals in the past 35 years. Only after the operation, the diagnosis of hemophilic arthritis was confirmed. Results This 42-year-old male patient felt painful, tired and discomfortable in both hips and knee joints at the age of 7, which was aggravated progressively, with the range of motion reduced gradually. Because of the symptoms stated above, he was misdiagnosed as“rheumatoid arthritis ( RA )”in the local hospital. While the symptomatic treatment did not work well. A month later, he was misdiagnosed as“double knee bone tuberculosis”in the local people’s hospital. Oral anti-tuberculosis drugs could not help relieve the symptoms, and pain, swelling and limited range of motion occurred repeatedly in both hips and knee joints in the following 35 years. The patient’s conditions worsened recently, and he was misdiagnosed as“double knee RA”in our hospital. Total knee arthroplasty was performed. Although such treatments were given to the wound postoperatively as pressure dressing, ice compress, atmospheric drainage and so on, the drainage volume reached up to 2400 ml at the 1st day after the operation and massive bleeding was continuously found at the wound dressing. We began to consider whether the patient had hematological diseases, and then we held a consultation with the doctors from the Hematology Department. The results showed that the specific coagulation factor VIII was 13.70 ( the normal values were 0.60-1.60 ), and the specific coagulation factor IX was 103.30 ( the normal values were 0.80-1.20 ). Finally, the diagnosis of hemophilia arthritis was confirmed. Conclusions The long-term misdiagnosis of this case of hemophilia arthritis is a profound lesson, which reminds the clinicians to strengthen the capability of inquiring the medical history. More attention is needed to detect the signs of related diseases and to improve the ability of differentially diagnosing different kinds of arthritis. When necessary, it is advised to hold a consultation with related specialists without delay.