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Prosthetic hip infection due to Cryptococcus neoformans: case report
Birgir Johannsson1, John J Callaghan
1Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. birgir-johannsson@uiowa.edu
Diagnostic Microbiology and Infectious Disease
|April 14, 2009
Summary
This case study describes the first prosthetic hip joint infection caused by Cryptococcus neoformans. Despite initial treatment and fluconazole suppression, the infection ultimately led to implant removal.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Prosthetic joint infections (PJIs) are serious complications following joint replacement surgery.
- Cryptococcus neoformans is an opportunistic fungal pathogen typically causing meningoencephalitis in immunocompromised individuals.
Observation:
- A rare case of prosthetic hip joint infection by Cryptococcus neoformans in an 84-year-old male with chronic lymphocytic leukemia.
- Initial symptoms included groin pain and fever, with radiographic evidence of prosthesis loosening.
- Fungal culture of joint aspirate confirmed C. neoformans infection.
Findings:
- Initial treatment with amphotericin B provided symptomatic relief.
- Subsequent suppressive oral fluconazole therapy, despite good joint penetration, failed to prevent PJI progression.
- The patient ultimately required prosthesis removal due to persistent pain and instability.
Implications:
- This case highlights the potential for C. neoformans to cause PJIs, a previously undescribed entity.
- Fluconazole suppressive therapy may be ineffective in prosthetic joint infections due to C. neoformans, possibly due to biofilm formation or host immune factors.
- Further research is needed to establish optimal treatment strategies for cryptococcal prosthetic joint infections.
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