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Haemarthrosis: case report A 78-year-old man developed haemarthrosis following dual‑antiplatelet therapy with aspirin and clopidogrel. The man had acute pain, swelling and heat at the knee of his paralysed left lower limb. He developed these symptoms, one month of inpatient rehabilitation for a new ischaemic stroke at his right periventricular region. Because of stroke recurrence, he started dual-antiplatelet therapy with aspirin and clopidogrel [routes and dosages not stated]. He had an evident history of hypertension, diabetes, dyslipidaemia, gout and chronic kidney disease. Due to the presenting symptoms, his stroke rehabilitation was terminated. The passive and active ranges of the knee were limited. Laboratory tests revealed mild leukocytosis and high CRP. Ultrasound (US)-guided knee arthrocentesis yielded massive bloody joint fluid. Synovial fluid cultures were negative. Calcium pyrophosphate (CPP) crystals were also found. Knee radiography identified soft-tissue swelling, osteophytes, joint space narrowing and chondrocalcinosis at medial joint space. Additionally, bone erosions at lateral femur and lateral border of the medial femur condyle were noted. US findings indicated interspersed fluid and proliferative synovium of multiple, villus-like, heterogeneous projections with hyperemia at the suprapatellar bursa and knee joint. On radiography, a thin layer of hyperechoic signal within the intercondylar cartilage correlated with chondrocalcinosis. MRI affirmed pigmented villonodular synovitis (PVNS) as the most possible cause of proliferative synovium and haemarthrosis. These findings were characteristic of "blooming artifact" of hemosiderin [time to reaction onset not stated]. The man was treated with unspecified antibacterials. For CPP arthritis, colchicine and prednisolone were started. Thereafter, he exhibited dramatic improvement. Repeated arthrocentesis also helped in relieving knee swelling. Till nine months, his knee remained symptom free. Later, he became bound to wheelchair due to poor stroke recovery. Hsieh S-F, et al. Concurrence of pigmented villonodular synovitis with calcium pyrophosphate deposition in a postacute stroke patient. Journal of Medical Ultrasound 28: 803517830 188-191, No. 3, Sep 2020. Available from: URL: http://doi.org/10.4103/JMU.JMU_107_19

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