Delayed Mycotic Prosthetic Joint Infection: A Rare Case Report

Fungal infections following total knee replacement surgeries are rare but present significant challenges in management due to their delayed diagnosis and resistance to standard antimicrobial therapies.

This case report describes the management of a delayed prosthetic joint infection in a 65-year-old female, diagnosed as a fungal infection 4 years after total knee replacement. Initially presented with persistent knee pain, swelling, and restricted range of motion despite standard antimicrobial therapy, further investigation revealed fungal elements in synovial fluid analysis, confirming the diagnosis. The patient underwent a staged procedure involving debridement, application of antifungal and antibiotic cement spacer, followed by delayed revision surgery. A 12-week course of antifungal fluconazole therapy was administered postoperatively. Subsequent 1-year follow-ups revealed symptomatic improvement and the absence of infection recurrence.

This case highlights the efficacy of staged surgical interventions and targeted antifungal therapy in achieving favorable outcomes for fungal prosthetic joint infections. It underscores the importance of long-term follow-up for monitoring and surveillance in such cases.