Culture-negative septic arthritis of the knee following traditional leech therapy: A management dilemma

Introduction: Septic arthritis caused by primitive leech therapy is an unusual and infrequent occurrence. Detecting this condition late can cause serious problems like joint damage and reduced mobility. This case report intends to showcase a rare instance of septic arthritis in the knee joint caused by primitive leech therapy, detailing its successful management. Case report: A 35-year-old female sought medical attention after undergoing primitive external leech therapy, presenting with symptoms of fever, severe progressive pain, and swelling in her left knee. Hematological examination revealed elevated total leukocyte count and c-reactive protein values. Arthroscopic debridement and joint lavage were performed, and synovial fluid analysis and histopathological examination of the tissue mass obtained from the affected joint confirmed the diagnosis of septic arthritis. Despite negative findings in gram staining, aerobic and anaerobic culture, and sensitivity reports, empirical therapy with 1 g of cefuroxime, a systemic intravenous antibiotic, was administered without any adverse events. Regular follow-ups were conducted, and evaluations of CRP and total count showed a complete resolution of the disease process. Conclusion: A high index of suspicion for septic arthritis should be maintained when dealing with primitive invasive intra-articular procedures like leech therapy. Appropriate scientific interventions and public awareness are crucial in reducing morbidity and preventing further complications associated with this rare condition.