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A painful knee in an immunocompromised patient.

Accepted 13 November 1995 A 34-year old Turkish man underwent an allogeneic bone marrow transplant as treatment of his chronic myeloid leukaemia. Five weeks later he was re-admitted complaining of severe pain in his previously normal left knee. On examination he was pyrexial, the knee was warm and slightly swollen with a small effusion but had a normal range of movement. Initial X-rays of the knee showed soft tissue swelling only but in subsequent films there was an increasing amount of air in the joint and surrounding soft tissues with scalloping of the femoral condyles. Joint aspiration produced only 5 ml of sterile, blood-stained fluid. Over the next two weeks the knee became more swollen with dusky discolouration anteriorly, that develoned into a large black. necrotic area (figure 1).