Aspergillus arthritis and organ transplantation

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Mycology

Background:

• Solid organ transplantation, such as kidney and pancreas transplants, requires long-term immunosuppression.
• Immunosuppression increases the risk of opportunistic infections, including fungal infections.
• Septic arthritis is a serious joint infection that can occur in immunocompromised patients.

Observation:

• A patient with a kidney and pancreas transplant presented with septic hip arthritis.
• Initial diagnostic work-up, including synovial and bone biopsies, was negative for infection.
• Empirical antibacterial antibiotic treatment was ineffective.

Findings:

• Tissue analysis after femoral head resection revealed Aspergillus fumigatus hyphae, confirming invasive fungal arthritis.
• Treatment with voriconazole (antifungal) and hip replacement resulted in complete recovery.
• The patient experienced cellular acute graft rejection due to drug interactions between immunosuppressants and voriconazole.

Implications:

• Aspergillus fumigatus arthritis is a rare but severe infection in transplant recipients.
• This diagnosis should be considered in immunocompromised patients with atypical or treatment-resistant septic arthritis.
• Careful management of drug interactions between antifungals and immunosuppressants is crucial in transplant patients.