Histoplasma capsulatum periprosthetic knee infection complicated by autoimmune-mediated systemic inflammatory...

Area of Science:

• Infectious Diseases
• Rheumatology
• Orthopedic Surgery

Background:

• Periprosthetic joint infections (PJIs) are serious complications of arthroplasty.
• Histoplasma capsulatum is an uncommon cause of PJIs, particularly in immunocompetent individuals.
• Early diagnosis and appropriate management are crucial for favorable outcomes.

Observation:

• A case of infectious knee monoarthritis caused by Histoplasma capsulatum in an immunocompetent patient post-unicompartmental knee arthroplasty.
• The infection progressed to disseminated histoplasmosis, triggering an autoimmune reaction and systemic inflammatory response syndrome.
• The patient presented with symptoms mimicking other inflammatory arthropathies.

Findings:

• Successful treatment involved staged arthroplasty reconstruction.
• Chronic antifungal therapy combined with steroid pharmacotherapy was key to managing the infection and inflammatory response.
• No signs of localized or systemic infection were observed at 4-year follow-up after total knee arthroplasty revision.

Implications:

• This case underscores the importance of considering rare fungal infections like histoplasmosis in the differential diagnosis of PJIs.
• Multidisciplinary management, including infectious disease, rheumatology, and orthopedic surgery, is essential for complex cases.
• Long-term antifungal and anti-inflammatory treatment may be necessary for successful eradication and functional recovery.