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Two-Stage Revision Total Knee Arthroplasty for Chronic Histoplasma Capsulatum Prosthetic Joint Infection: A Case
Brady T Williams1, Craig Hogan1, Laura Damioli2
1University of Colorado, Department of Orthopaedics; Aurora, Colorado.
Case:
This report describes a histoplasma capsulatum total knee prosthetic joint infection (PJI) in an immunosuppressed patient treated with a 2-stage revision. The diagnosis of PJI was made based on minor criteria, and the causative organism was identified from cultures obtained at the time of explantation. The patient underwent induction with amphotericin B, followed by oral antifungal therapy and a successful 2-stage revision with a hinged prosthesis with an interval of ∼7 months between stage 1 and stage 2. At the most recent follow-up (18 months), she remained clear from infection with planned lifetime antifungal suppression.
Conclusion:
This case report highlights the importance of consideration of atypical organisms when treating immunocompromised patients. Furthermore, this case report documents one of the few cases of histoplasma PJI and provides a successful treatment algorithm to potentially be applied to future cases.
Insights
This case report details a rare fungal prosthetic joint infection (PJI) caused by Histoplasma capsulatum in an immunosuppressed patient. A successful 2-stage revision surgery and antifungal therapy led to infection clearance.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Mycology
Background:
- Prosthetic joint infections (PJI) are serious complications of joint replacement surgery.
- Immunocompromised patients are at increased risk for opportunistic infections, including fungal pathogens.
- Histoplasma capsulatum is an endemic fungus that can cause disseminated disease in immunocompromised individuals.
Observation:
- A case of Histoplasma capsulatum prosthetic joint infection (PJI) in the knee of an immunosuppressed patient is presented.
- Diagnosis was established using minor criteria for PJI and confirmed by fungal cultures.
- The patient presented with symptoms suggestive of deep infection post-total knee arthroplasty.
Findings:
- The patient underwent a 2-stage revision surgery for the PJI.
- Initial treatment involved intravenous amphotericin B, followed by oral antifungal medication.
- A hinged prosthesis was used in the second stage, with a 7-month interval between stages.
- At 18 months post-surgery, the patient remained free of infection and was on lifelong antifungal suppression therapy.
Implications:
- This case underscores the importance of considering atypical organisms, such as Histoplasma, in the differential diagnosis of PJI in immunocompromised patients.
- The successful management highlights a viable treatment algorithm for rare fungal PJIs, involving surgical intervention and targeted antifungal therapy.
- This report contributes to the limited literature on Histoplasma PJI and offers insights for clinical practice.
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