Prosthetic hip infection due to Cryptococcus neoformans: case report.
Prosthetic joint infections due to Cryptococcus neoformans have not been described before. We report a case of a prosthetic hip joint infection due to C. neoformans. An 84-year-old man with chronic lymphocytic leukemia presented with progressive left groin pain and fever. There was radiographic evidence of prosthesis loosening, and an aspirate of the left hip joint grew C. neoformans. The patient was treated with amphotericin B with good initial symptomatic response. The patient elected not to undergo revision arthroplasty, and oral suppressive therapy with fluconazole was initiated. After 10 months of fluconazole therapy, the prosthesis was removed secondary to pain and increased instability of the implant. Despite excellent penetration of fluconazole into the joint fluid and reports of successful outcome in patients with native joint cryptococcal infections as well as prosthetic joint infections due to Candida spp., suppressive fluconazole therapy failed. The failure may have been due to an unfavorable interaction between the organism and immune mechanism as well as reduced activity of fluconazole in biofilm.
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. birgir-johannsson@uiowa.edu
Birgir
B
Johannsson
John J
JJ
Callaghan
D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D015725:Fluconazole / Q000627:therapeutic use; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D011859:Radiography
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole