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Monday, June 15, 2009

Localized Herx: knee

A patient presented to me with an acute swollen knee. She had been healthy until another physician prescribed a course of Cipro for a urinary tract infection.
She had typical mono-articular arthritis: arthritis of a single joint. The knee was swollen, red an hot with a large effusion. The patient tested positive for Lyme disease and was successfully treated.

This- I think may demonstrate the concept which I alluded to in the response to my last entry. First of all many ostensibly healthy persons are infected with sub-clinical Lyme. Something- many things, can set off the disease. Second, Herxes can be very localized, presenting in a specific area.

Many thinking in this case was that the Lyme organisms were present in the synovial tissues of this patent's knees. Cipro, a quinolone, was able to have exceptional penetration in to these tissues. As a result, this localized Herx occurred in the patient's knee. Post-quinolone treatment relied on less potent antibiotic, which have less penetration into synovial tissues. These tissues are minimally penetrated by most other antibiotics.Therapy with Amoxil and Biaxin, over time, was successful:swelling and arthritis gradually improved.

It is pure conjecture. I simply ask the question: could tendon rupture seen with quinolones represent a similar reaction?


Anonymous said...

Excellent thought!


I just got put on Cipro and Zithromax and I am nervous. Do you prescribe Cipro? I don't think I have herxed yet and am I worried about Cipro's side effects. I am also about to have the mercury taken out of my mouth and noticed that you are supposed to tell your doctor if you have surgery including dental surgery on Cipro.


Uh-oh, I jsut saw the psot below about Cipro. Will read it.

Shawn said...

Cipro make my knees sore and from my experience I don't think it's a localized herx. They feel like they do when I'm on my feet all day. Applying heat helps.

smells said...

Four days into my antibiotic treatment both my knees got swollen and tight. I've never had problems with my knees before. Now I'm on my 3rd week of treament and my knees are 95% better. Now I'm having flu like symptoms I know I'm definitely herxing.