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Severe prosthetic joint infection in an immunocompetent male patient due to a therapy refractory Pseudallescheria

M Lackner1, F H De Man, D Eygendaal

  • 1Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria.

Mycoses
|October 15, 2011
PubMed

Insights

This case study details a rare prosthetic joint infection (PJI) caused by multidrug-resistant Pseudallescheria apiosperma. The infection was successfully treated with surgery and a combination antifungal therapy, including voriconazole and terbinafine.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Orthopedic Surgery

Background:

  • Prosthetic joint infections (PJI) are uncommon fungal infections, typically caused by Candida species.
  • Pseudallescheria apiosperma is a rare but aggressive fungal pathogen.
  • Infections usually occur after penetrating trauma, but this case involved spontaneous joint infection.

Observation:

  • A 61-year-old immunocompetent male developed a persistent prosthetic knee infection (>4 years).
  • The infection was caused by a multidrug-resistant strain of Pseudallescheria apiosperma.
  • Initial treatments with itraconazole and voriconazole showed poor response, leading to amputation.

Findings:

  • The patient experienced multiple therapeutic failures.
  • Surgical interventions combined with prolonged antifungal therapy (voriconazole and terbinafine) led to a cure.
  • This case highlights a rare, non-traumatically acquired, and persistent PJI.

Implications:

  • This case expands the understanding of Pseudallescheria apiosperma PJI in immunocompetent individuals.
  • It underscores the importance of combination antifungal therapy and surgical intervention for refractory cases.
  • Highlights the need for considering rare fungal pathogens in PJI diagnosis and treatment.

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