Relative neutropenia may also be produced by poor perfusion stemming from trauma, radiation damage, vascular disease, or anti-inflammatory actions of glucocorticoids.6 Sickle cell anemia also compromises host defenses through autosplenectomy. Physicians manage such complications in typical patients well, but the immunocompromised patients have an increased morbidity. An increasing prevalence of immunodeficiency, whether primary, iatrogenic, or therapeutic, raises concern regarding infectious complications of treatment. Induced immunosuppression following transplant surgery is of particular concern. Superimposed on immunosuppressant therapy, the previously discussed conditions predisposing to infection, especially IDD, further compromise many patients.
Case reports account for most documentation.
The relative paucity of information may reflect actual infrequency or it could simply represent under-reporting of cases. In one of the few available studies, a group at the University of Pennsylvania School of Medicine investigated septic arthritis in 800 renal transplant recipients over an 18 year period. Results showed only six cases of septic arthritis, with five involving the knee and one affecting the ankle. Anti-rejection medications included prednisone and azathioprine with no significant dosage differences among patients. Regarding other predisposing conditions, two patients had diabetes mellitus, one had chronic S. aureus skin infection, one had prior infection of the same joint with the same organism, and one had prior infection of the same joint with a different organism.