Pseudallescheria boydii knee arthritis in a young immunocompetent adult two years after a compound patellar fracture.
Pseudallescheria boydii arthritis of the knee developed in a 32-year-old immunocompetent man 2 years after a compound patellar fracture contaminated with soil. No other potential portal of entry was identified, suggesting that the fungus remained latent for 2 years. Pseudallescheria arthritis often occurs after a prolonged latency period, causing minimal symptoms that contrast with the frequently severe radiological changes. Although this organism often shows limited sensitivity to most antifungal agents, our patient achieved a full recovery after surgical synovectomy and 6 months of itraconazole therapy (400 mg/ d). This case illustrates the importance of testing for fungi in patients with torpid arthritis, particularly when mild clinical symptoms contrast with severe bone and joint destruction.
Lavy
D
D
Rheumatology Department, Hôtel-Dieu, CHU Nantes, France.
Morin
O
O
Venet
G
G
Maugars
Y
Y
Prost
A
A
Berthelot
J M
JM
D000328:Adult; D001170:Arthritis, Infectious / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D050723:Fractures, Bone / Q000150:complications* / Q000473:pathology; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007718:Knee Injuries / Q000150:complications* / Q000473:pathology; D007719:Knee Joint / Q000382:microbiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008271:Mycetoma / Q000150:complications* / Q000473:pathology / Q000628:therapy; D010329:Patella / Q000293:injuries / Q000473:pathology; D011541:Pseudallescheria / Q000302:isolation & purification*; D000074402:Synovectomy; D016896:Treatment Outcome
D017964:Itraconazole