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Bilateral septic arthritis of the knee joint in three children caused by unusual infectious agents

reports in adults with an underlying or predisposing factor such as joint prostheses, collagen vascular disease, arthropathy and/or their therapies.1–6 As far as we know, there has been only one report describing bilateral septic arthritis of the shoulder in children.7 In this report, three children were presented with septic arthritis of both knee joints mimicking juvenile rheumatoid arthritis (JRA). They all had important underlying or predisposing factors, such as panhypogammaglobulinemia (common variable immune deficiency), severe congenital heart disease (operated transposition of the great arteries) and systemic type JRA. All of the children also had anemia. The causes were unusual microorganisms such as Proteus mirabilis and Candida albicans (both agents were yielded from both synovial fluids). In the third case, Gram stains of two separate synovial fluids demonstrated Gram-positive cocci located inside and around the neutrophils with negative bacterial cultures.