Bread mold osteomyelitis in the femur

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Mycology

Background:

• Rhizopus osteomyelitis is a rare, severe infection, typically affecting immunocompromised individuals.
• Standard treatment involves Amphotericin B, surgical debridement, and potentially amputation.
• Postoperative infections can be challenging to manage, especially in healthy patients.

Observation:

• A healthy patient developed Rhizopus osteomyelitis after anterior cruciate ligament repair.
• Clinical signs included knee swelling, stiffness, weight loss, and decreased range of motion.
• Magnetic resonance imaging revealed fluid collection, and arthrocentesis confirmed Rhizopus species.

Findings:

• Limb salvage was attempted using multiple surgical debridements, Amphotericin B-loaded cement spacers, systemic antifungal therapy, and hyperbaric oxygen.
• Four surgeries were required, followed by distal femoral endoprosthesis placement.
• The patient achieved normal laboratory values and negative fungal cultures, with no recurrence at 3-year follow-up.

Implications:

• Aggressive, multimodal treatment can be successful in limb salvage for Rhizopus osteomyelitis in healthy patients.
• This case highlights the importance of considering rare fungal infections postoperatively.
• Further research into optimal treatment strategies for Rhizopus osteomyelitis is warranted.