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Medical Science Monitor Basic Research


Acute Opioid Withdrawal Mimicking Postoperative Joint Infection Following anterior cruciate ligament (ACL) Reconstruction: A Case Report

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Unexpected drug reaction

Qingwu Kong, Martin Griffis, Brandon J. Shallop, Amrit S. Khalsa, Kyle Brougham, Paul A. Marchetto

USA Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA

Am J Case Rep 2020; 21:e923458

DOI: 10.12659/AJCR.923458

Available online: 2020-05-14

Published: 2020-06-22

BACKGROUND: A short course of opioid narcotics is often prescribed for postoperative anterior cruciate ligament (ACL) reconstruction pain management. Unfortunately, there is a well-documented incidence of opioid withdrawal syndrome (OWS) following short-term use of these medications. OWS can present with symptoms such as influenza-like illness. It is important to differentiate OWS from infectious illnesses, especially after surgery.
CASE REPORT: We present a case of OWS in a patient who underwent ACL reconstruction 7 days prior. The patient’s OWS symptoms were similar to symptoms of a postoperative infection. The knee was aspirated, and the analysis of the aspirate was not concerning for an infection. The patient’s symptoms spontaneously resolved on postoperative day 10. This is the first documented case of OWS mimicking ACL reconstruction joint infection.
CONCLUSIONS: OWS after surgery may present with symptoms similar to joint infection. It is important to consider OWS as a potential complication after surgery and differentiate it from infection to avoid any further unnecessary invasive treatments for the patient.

Keywords: Analgesics, Opioid, anterior cruciate ligament reconstruction, Arthritis, Infectious