Non-infectious arthritis of the knee, malnutrition due to monocytic malabsorption, and parental bonding disorder. A case report

Abstract

The case of a boy aged 9 months who was admitted by an unusual presentation of knee

arthritis and monocytic malabsorption syndrome which carried him into a persistent se-
vere malnutrition and into death is reported. Body weight at 9 months was 4,000 grams.

A left knee big swelling was misdiagnosed as sceptic arthritis and so operated on, with
postoperative negative cultures, persistent joint swelling and poor response to antibiotics.
After repeating flare-ups of olygoarticular minor onsets and non-granulomatous uveitis, an
autoimmune process was suspected. Monocytic malabsorption diagnosis was established
after endoscopic biopsy, as a result of presence of inflammatory monocyte infiltration over
the lamina propia at the jejunal mucosa. Positive HLA-B27 antigen as well as increased
IL-6, C-reactive protein up to 65.8 mg/dL and sedimentation rate of 53 mm, were all
non-conclusive supportive features for autoimmunity. Patient never gained body weight
in spite of different unsuccessful efforts to nourish him. His prevalent general poor health
condition was misinterpreted by his relatives as something normal for that baby, as the
aberrant parental rationale was to refuse a late attempt to furnish feeding into a specialized
non-cost nutritional facility (White Cross Hospital). Diagnosis of disvinculation disorder
of parental-child bonding was so established. After relieving from pneumonia, patient abdominal distention. Bleeding is described since infiltrated mucous membrane of gut is
highly sensitive even to minor trauma.