Case: An 81-year-old man from the northeastern United States presented with an acute Borrelia burgdorferi prosthetic joint infection (PJI) 15 years after undergoing a right total knee arthroplasty. He had no complications until his recent presentation. He was treated with irrigation and debridement with implant retention. Synovial fluid Lyme polymerase chain reaction and serological tests were positive. Postoperatively, he received oral doxycycline and at 6 weeks was asymptomatic. Four months later, he died of neuroborreliosis vasculitis, a complication of Lyme.
Conclusion: We recommend considering Lyme disease as a cause of culture-negative PJIs in endemic regions. Early surgical treatment may mitigate adverse outcomes of Lyme.
Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.