Hip Pelvis 2015; 27(3): 196-200
Published online September 30, 2015
https://doi.org/10.5371/hp.2015.27.3.196
© The Korean Hip Society
Correspondence to : Kee Hyung Rhyu, MD
Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
TEL: +82-2-440-6156 FAX: +82-2-440-6296
E-mail: khrhyu@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
We present a case of Aspergillus septic hip arthritis in an immunocompetent patient with undiagnosed recurrent pulmonary aspergillosis who underwent arthroscopic surgery. Biopsy specimens of synovium revealed fungal hyphae, confirming Aspergillus infection. Aspergillus septic hip arthritis can occur in immunocompetent patients, and arthroscopy can be a noninvasive surgical option in these cases.
Keywords Hip, Aspergillus, Arthritis, Infectious, Arthroscopy
Although
A 49-year-old female presented with a 3-month history of progressive pain and limited range of motion of the right hip, showing no fever and no indication of localized heat, redness, and soft tissue swelling around the hip. An anteroposterior hip radiograph showed a slight narrowing of the joint space in the right hip (Fig. 1A). A magnetic resonance image revealed marked joint effusion, and edematous changes of the bone marrow and muscles around the right hip joint (Fig. 1B). Her laboratory results were as follows: white blood cells (WBC), 12.2/mm3; erythrocyte sedimentation rate, 69 mm/hr; C-reactive protein, 2.56 mg/dL.
We decided to perform a hip arthroscopy on both diagnostic and therapeutic purpose, suspecting septic arthritis based on the images and laboratory findings. Arthroscopic findings included intra-articular hematoma and hyperemic synovium overlaying the entire acetabular labrum and joint capsule (Fig. 2A). There was some hypertrophic synovial tissue in the acetabular fossa invading the subchondral bone and erosion of acetabular cartilage (Fig. 2B). A synovectomy was performed using an arthroscopic shaver and a radiofrequency probe. Synovial biopsy samples were taken for culture and histological examination. High-volume irrigation using 30 L of normal saline was performed. The cultures contained no bacterial, fungal, or mycobacterial growth. However, biopsy specimens revealed fungal hyphae in the fibrous tissue and chronic active inflammation with abscess formation, confirming a diagnosis of
After the hip arthroscopy, intravenous amphotericin B was administered for 2 weeks, followed by voriconazole, orally administered for 6 months. Hematologic and biochemical test results had normalized at 4 months after surgery; however, at 9 months after surgery she underwent a total hip arthroplasty (THA) due to persistent pain with severe joint space narrowing visible on plain radiographs (Fig. 4). Postoperative cultures did not have any fungal growth and fungal organisms were not found in histological examinations. Nineteen months after the THA, the patient presented no signs of infection recurrence.
We describe a case of
There is no consensus on the type of antifungal therapy for treatment of
Although the
As in this case, septic arthritis caused by fungi tends to be more indolent than bacterial septic arthritis, and diagnostic tools routinely used for septic arthritis such as joint fluid analysis or culture may not be helpful1). This forces surgeons to be alert to the possibility of fungal joint infection, as late diagnosis is often followed by poor prognosis.
In summary, another case of
Hip Pelvis 2015; 27(3): 196-200
Published online September 30, 2015 https://doi.org/10.5371/hp.2015.27.3.196
Copyright © The Korean Hip Society.
Pil Whan Yoon, MD, Joo Ho Song, MD, Kang Sup Yoon, MD*, Jae Suk Chang, MD, Hee Joong Kim, MD†, Kee Hyung Rhyu, MD‡
Department of Orthopaedic Surgery, Asan Medical Center, Seoul, Korea
Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea*
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea†
Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea‡
Correspondence to:Kee Hyung Rhyu, MD
Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
TEL: +82-2-440-6156 FAX: +82-2-440-6296
E-mail: khrhyu@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
We present a case of Aspergillus septic hip arthritis in an immunocompetent patient with undiagnosed recurrent pulmonary aspergillosis who underwent arthroscopic surgery. Biopsy specimens of synovium revealed fungal hyphae, confirming Aspergillus infection. Aspergillus septic hip arthritis can occur in immunocompetent patients, and arthroscopy can be a noninvasive surgical option in these cases.
Keywords: Hip, Aspergillus, Arthritis, Infectious, Arthroscopy
Although
A 49-year-old female presented with a 3-month history of progressive pain and limited range of motion of the right hip, showing no fever and no indication of localized heat, redness, and soft tissue swelling around the hip. An anteroposterior hip radiograph showed a slight narrowing of the joint space in the right hip (Fig. 1A). A magnetic resonance image revealed marked joint effusion, and edematous changes of the bone marrow and muscles around the right hip joint (Fig. 1B). Her laboratory results were as follows: white blood cells (WBC), 12.2/mm3; erythrocyte sedimentation rate, 69 mm/hr; C-reactive protein, 2.56 mg/dL.
We decided to perform a hip arthroscopy on both diagnostic and therapeutic purpose, suspecting septic arthritis based on the images and laboratory findings. Arthroscopic findings included intra-articular hematoma and hyperemic synovium overlaying the entire acetabular labrum and joint capsule (Fig. 2A). There was some hypertrophic synovial tissue in the acetabular fossa invading the subchondral bone and erosion of acetabular cartilage (Fig. 2B). A synovectomy was performed using an arthroscopic shaver and a radiofrequency probe. Synovial biopsy samples were taken for culture and histological examination. High-volume irrigation using 30 L of normal saline was performed. The cultures contained no bacterial, fungal, or mycobacterial growth. However, biopsy specimens revealed fungal hyphae in the fibrous tissue and chronic active inflammation with abscess formation, confirming a diagnosis of
After the hip arthroscopy, intravenous amphotericin B was administered for 2 weeks, followed by voriconazole, orally administered for 6 months. Hematologic and biochemical test results had normalized at 4 months after surgery; however, at 9 months after surgery she underwent a total hip arthroplasty (THA) due to persistent pain with severe joint space narrowing visible on plain radiographs (Fig. 4). Postoperative cultures did not have any fungal growth and fungal organisms were not found in histological examinations. Nineteen months after the THA, the patient presented no signs of infection recurrence.
We describe a case of
There is no consensus on the type of antifungal therapy for treatment of
Although the
As in this case, septic arthritis caused by fungi tends to be more indolent than bacterial septic arthritis, and diagnostic tools routinely used for septic arthritis such as joint fluid analysis or culture may not be helpful1). This forces surgeons to be alert to the possibility of fungal joint infection, as late diagnosis is often followed by poor prognosis.
In summary, another case of
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