Periprosthetic hip infection by Francisella tularensis

Francisella tularensis is an uncommon cause of osteoarticular infection and an exceptionally rare cause of periprosthetic joint infection. Diagnosis may be delayed because clinical suspicion is low and microbiological identification requires specific culture conditions and careful biosafety precautions. We describe a 63-year-old man with prosthetic hip joint infection caused by Francisella tularensis subspecies holarctica following rural exposure. Diagnosis relied on leukocyte-labelled scintigraphy, synovial fluid inoculation and incubation in blood culture bottles, and serology. Doxycycline and one-stage prosthesis exchange led to resolution, highlighting this rare cause of periprosthetic joint infection.