Cryptococcus neoformans Prosthetic Joint Infection: Case Report and Review of the Literature

• Published in: Mycopathologia (1975) 2015-04, Vol.179 (3-4), p.275-278
• Main Authors: Shah, Neel B., Shoham, Shmuel, Nayak, Seema
• Format: Article
• Language: English
• Subjects: Aged; Amphotericin B; Antibacterial agents; Antifungal Agents - therapeutic use; Antiparasitic agents; Arthroplasty, Replacement, Hip - adverse effects; Biomedical and Life Sciences; Candida; Case reports; Cryptococcosis - drug therapy; Cryptococcosis - etiology; Cryptococcosis - microbiology; Cryptococcus neoformans; Cryptococcus neoformans - genetics; Cryptococcus neoformans - isolation & purification; Cryptococcus neoformans - physiology; Diabetes; Diabetics; Eukaryotic Microbiology; Female; Fluconazole; Fluconazole - therapeutic use; Health aspects; Hematoma; Hip dislocation; Human immunodeficiency virus; Humans; Infection; Infections; Infectious diseases; Internal medicine; Joint Prosthesis - microbiology; Life Sciences; Literature reviews; Medical Microbiology; Microbial Ecology; Microbiology; Myasthenia gravis; Plant Sciences; Prostheses; Prostheses and implants
• ISSN: 0301-486X; 1573-0832
• DOI: 10.1007/s11046-014-9847-0

A 77-year-old woman with diabetes mellitus, myasthenia gravis and bilateral total hip arthroplasties underwent a two-stage procedure followed by treatment with vancomycin for a coagulase-negative staphylococcal prosthetic hip infection. This was complicated by a spontaneous left hip dislocation with a hematoma that was evacuated; all intraoperative cultures grew out Cryptococcus neoformans. Treatment with intravenous liposomal amphotericin B was started. Her prosthetic device was retained, and she was treated for 12 weeks, after which she was transitioned to fluconazole for long-term therapy. The hip remained stable 1 year out from her admission, and she retained mobility with the assistance of a walker. Fungi are an uncommon but potentially devastating cause of prosthetic joint infections, and most are due to Candida species [ 1 ]. Cryptococcus neoformans is an ubiquitous yeast with worldwide distribution that generally causes infections in patients with major T cell immune deficiencies (e.g., HIV, transplantation and receipt of corticosteroids). Cryptococcal infections of native osteoarticular structures are uncommon, but have been well described in the literature [ 2 , 3 ]. Data regarding cryptococcal prosthetic joint infections, however, are sparse [ 4 ].