Young men with bilateral pain in the lower part of patella.

Received Accepted Med Ultrason 2013, Vol. 15, No 3, 250-251 Corresponding author: Florentin Vreju Rheumatology Department, University of Medicine and Pharmacy Craiova Petru Rares 2-4, Craiova, Romania Email: [email protected] Male patient, 34 years old, without significant family history, diagnosed with autoimmune hepatitis and treated with high dose of corticosteroids for about 2 years, tapered to 5 mg per day, was admitted to our clinic for knees tenderness, with a predominance in the right one. The pain was increasing with activity, especially when extending the knee against force, like stair climbing and jumping. The clinical examination revealed nothing but tenderness in the patellar tendon insertion on the patella. Laboratory tests showed no inflammatory syndrome, with an erythrocyte sedimentation rate of 7 mm/1h and C-reactive protein 0,2 mg/dl and no changes in the other tests (serum uric acid, RF, blood glucose), including normal ASAT and ALAT. Ultrasound examination showed no significant changes in the upper knee, with just a slight bilateral amount of fluid in the lateral parapatellar boursa. The lower knee examination revealed bilaterally an enlargement of the proximal part of the patellar tendon and big irregularities of the distal kneecap (patella) and important hyperechoic line inside the tendon, with acoustic shadowing (fig 1, fig 2). There was no pathological Doppler signal finding at the level of the knee.