Erysipelothrix rhusiopathiae Prosthetic Joint Infection in an Immunocompromised Patient: A Case Report

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Microbiology

Background:

• Prosthetic joint infection (PJI) poses significant challenges in orthopedic surgery.
• Erysipelothrix rhusiopathiae is an uncommon pathogen implicated in PJI, particularly in immunocompromised individuals.
• Hematogenous seeding from cutaneous erysipeloid is a potential route of infection.

Observation:

• A 65-year-old immunosuppressed male presented with PJI 23 years after initial surgery.
• The infection was caused by Erysipelothrix rhusiopathiae, likely from a cutaneous erysipeloid lesion.
• Treatment involved immunotherapy cessation, surgical washout, and tailored antimicrobial therapy.

Findings:

• The patient received suppressive oral ciprofloxacin monotherapy post-discharge.
• A first-stage revision surgery was performed 5 months after presentation.
• Postoperative aspiration at 1 year showed no organisms or leukocytes, indicating successful infection control.
• At 18 months, the patient remains clinically well, opting against a second-stage revision.

Implications:

• Erysipelothrix rhusiopathiae should be considered in the differential diagnosis of PJI, especially in patients with immunosuppression and relevant exposure history.
• This case demonstrates the feasibility of managing late-onset PJI due to E. rhusiopathiae with a combination of medical and surgical interventions.
• Successful treatment achieved a good clinical outcome without sequelae, potentially avoiding extensive reconstructive surgery in select cases.