Prosthetic hip infection due to Cryptococcus neoformans : case report

Abstract 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 radiogr...

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Bibliographic Details
Published in:Diagnostic microbiology and infectious disease 2009-05, Vol.64 (1), p.76-79
Main Authors: Johannsson, Birgir, Callaghan, John J
Format: Article
Language:English
Subjects:
Aged, 80 and over
Amphotericin B - therapeutic use
Antifungal Agents - therapeutic use
Arthroplasty, Replacement, Hip - adverse effects
Biofilm
Biological and medical sciences
Candida
Cryptococcosis
Cryptococcosis - diagnosis
Cryptococcosis - drug therapy
Cryptococcosis - microbiology
Cryptococcosis - surgery
Cryptococcus neoformans
Cryptococcus neoformans - isolation & purification
Fluconazole - therapeutic use
Fluconazole therapy
Fundamental and applied biological sciences. Psychology
Hip - diagnostic imaging
Humans
Infectious Disease
Infectious diseases
Internal Medicine
Male
Medical sciences
Microbiology
Miscellaneous
Mycology
Prosthesis-Related Infections - drug therapy
Prosthesis-Related Infections - microbiology
Prosthesis-Related Infections - surgery
Prosthetic joint infection
Radiography
Suppressive therapy
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Summary:Abstract 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.
ISSN:0732-8893
1879-0070
DOI:10.1016/j.diagmicrobio.2009.01.005