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[Disseminated aspergillosis after intra-articular corticosteroid infiltrations]

H Durox1, A Boumediene, C Genet

  • 1Service des maladies infectieuses et tropicales, CHU Dupuytren, Limoges, France. helene.durox@wanadoo.fr

Medecine Et Maladies Infectieuses
|March 6, 2007
PubMed

Insights

A rare case of Aspergillus fumigatus causing septic arthritis in an elderly woman after corticosteroid treatment highlights the need for considering fungal infections in persistent joint inflammation.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Rheumatology

Background:

  • Bone and joint infections by Aspergillus are uncommon, primarily affecting immunocompromised individuals.
  • Corticosteroid therapy can predispose patients to opportunistic infections.
  • Persistent, treatment-resistant arthritis warrants thorough etiological investigation.

Observation:

  • An 84-year-old woman presented with chronic, treatment-refractory left knee arthritis.
  • Despite multiple arthrocenteses, no pathogen was initially identified.
  • Arthroscopy revealed Aspergillus fumigatus in synovial fluid, indicating invasive fungal arthritis.

Findings:

  • The patient developed disseminated aspergillosis with severe osteo-articular destruction.
  • Infection involved blood and urinary systems.
  • Despite systemic voriconazole, intra-articular treatment, and surgical debridement, the patient succumbed to the infection.

Implications:

  • Septic arthritis due to Aspergillus fumigatus, though rare, is a critical differential diagnosis following corticosteroid infiltration.
  • Aggressive and destructive potential of fungal arthritis necessitates early and accurate diagnosis.
  • This case underscores the importance of considering non-bacterial pathogens in refractory septic arthritis.

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