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Disseminated Aspergillus flavus following septic arthritis in an immunocompetent patient: a case report
Vivek Tiwari, Kavin Khatri, Shah Alam Khan1
1Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, India. shahalamkhan70@gmail.com.
Background:
Aspergillosis is a rare cause of osteomyelitis and septic arthritis. Aspergillus osteomyelitis is a debilitating infection affecting both immunocompromised and immunocompetent patients. It is associated with a high incidence of morbidity and mortality. Infection with Aspergillus flavus species in the knee has been very rarely seen in the past.
Case Presentation:
We present a case of septic arthritis of the knee in an Indian patient secondary to infection with Aspergillus flavus, which was earlier managed as a case of tuberculosis based on the endemicity of the condition, later leading to disseminated aspergillosis. There was no clinical feature or investigation suggesting immunocompromised state. Following knee arthrotomy, Aspergillus flavus was isolated and patient was subsequently managed with antifungals leading to recovery after three months.
Conclusions:
Disseminated aspergillosis can mimic tuberculosis both clinically and radiologically. Though fungal infections affect joints rarely but they must always be ruled out to avoid later complications.
Insights
Aspergillus flavus rarely causes knee infections, mimicking tuberculosis. Prompt diagnosis and antifungal treatment are crucial for recovery from this debilitating condition.
Area of Science:
- Infectious Diseases
- Mycology
- Orthopedics
Background:
- Aspergillosis, a fungal infection, infrequently leads to osteomyelitis and septic arthritis.
- Aspergillus osteomyelitis presents a significant challenge, impacting both immunocompromised and immunocompetent individuals with high morbidity and mortality rates.
- Infections caused by Aspergillus flavus, particularly in the knee joint, are exceptionally rare.
Observation:
- A case of knee septic arthritis in an Indian patient caused by Aspergillus flavus is presented.
- The initial diagnosis was tuberculosis due to the prevalence of the disease, leading to delayed identification of disseminated aspergillosis.
- The patient showed no signs of being immunocompromised, complicating the diagnostic process.
Findings:
- Knee arthrotomy revealed Aspergillus flavus as the causative agent.
- The patient received antifungal therapy, resulting in complete recovery within three months.
- Disseminated aspergillosis can present with clinical and radiological features similar to tuberculosis.
Implications:
- Fungal joint infections, though uncommon, necessitate consideration in differential diagnoses to prevent severe outcomes.
- Early and accurate diagnosis of fungal infections is vital for effective management and improved patient prognosis.
- This case highlights the importance of considering rare pathogens in endemic regions, even in the absence of typical risk factors.