Periprosthetic Joint Infection Caused by Trichoderma: Is It Plausible?

Background and Clinical Significance:Trichoderma is a rare cause of human fungal infections. These infections are often severe and can be life-threatening, involving various organs and tissues. Although Trichoderma is not commonly encountered in clinical practice, its ability to cause infections is particularly significant in immunocompromised patients. As a result, cases in which Trichoderma is identified in human specimens are not only uncommon but also pose complex diagnostic and therapeutic challenges for clinicians. Although it can be associated with various organs, its clinical significance in joints, especially in periprosthetic joint infections, remains unclear. Case Presentation: This case report presents a 63-year-old immunocompromised woman with a suspected periprosthetic joint infection caused by Trichoderma. After total hip arthroplasty and subsequent bacterial periprosthetic joint infection, Trichoderma was revealed from two intraoperative samples. Given the unusual pathogen and the patient's immunosuppression, antifungal therapy with amphotericin B was initiated. However, due to severe intolerance, the antifungal treatment had to be discontinued shortly after initiation, and the patient continued under close monitoring. We closely monitored the patient's clinical status and laboratory test results, continuously considering whether the findings represented contamination or true infection. The patient exhibited clinical and radiological stability, reinforcing the hypothesis of contamination rather than active infection. Conclusions: This case explores the rarity of Trichoderma periprosthetic joint infections, the diagnostic and treatment challenges, and the importance of multidisciplinary input in managing such uncommon and complex cases. Further studies are needed to clarify the pathogenic significance, optimal management, and long-term outcomes of Trichoderma in bone and joint infections.