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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
Abstract:
Prosthetic joint infections due to Cryptococcus neoformans have not been described before. We report a case of a prosthetic hip joint infection due to C. neoformans. An 84-year-old man with chronic lymphocytic leukemia presented with progressive left groin pain and fever. There was radiographic evidence of prosthesis loosening, and an aspirate of the left hip joint grew C. neoformans. The patient was treated with amphotericin B with good initial symptomatic response. The patient elected not to undergo revision arthroplasty, and oral suppressive therapy with fluconazole was initiated. After 10 months of fluconazole therapy, the prosthesis was removed secondary to pain and increased instability of the implant. Despite excellent penetration of fluconazole into the joint fluid and reports of successful outcome in patients with native joint cryptococcal infections as well as prosthetic joint infections due to Candida spp., suppressive fluconazole therapy failed. The failure may have been due to an unfavorable interaction between the organism and immune mechanism as well as reduced activity of fluconazole in biofilm.
Insights
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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