Durox H, Boumediene A, Genet C, Lo Ré P, Rogez J-P, Weinbreck P, Denes E
Service des maladies infectieuses et tropicales, CHU Dupuytren, Limoges, France.
Med Mal Infect. 2007 Sep;37(9):609-12. doi: 10.1016/j.medmal.2006.12.008. Epub 2007 Mar 1.
Bone and joint infections due to Aspergillus are rare and occur more commonly in immunosuppressed patients. We report the case of an 84-year-old woman who developed septic arthritis caused by Aspergillus fumigatus after corticosteroid infiltration. This patient had presented with arthritis of the left knee for several months but no microorganism had been found despite numerous arthrocenteses. This arthritis was resistant to treatment by numerous corticosteroid infiltrations. During an arthroscopy, analysis of the synovial fluid yielded A. fumigatus. Thereafter, other explorations showed disseminated aspergillosis with osteo-articular destruction, blood and urinary dissemination. A systemic treatment by voriconazole associated to intra-articular injections and surgical debridement was initiated but the patient died. Septic arthritis caused by A. fumigatus is very rare but must be considered as a differential diagnosis of septic arthritis after corticosteroid infiltration. Their complications can be very important and destructive.
由曲霉菌引起的骨与关节感染较为罕见，在免疫抑制患者中更为常见。我们报告一例84岁女性患者，在接受皮质类固醇注射后发生了由烟曲霉引起的化脓性关节炎。该患者左膝关节炎已有数月，但尽管进行了多次关节穿刺，仍未发现微生物。这种关节炎对多次皮质类固醇注射治疗均有抵抗。在关节镜检查期间，对滑液的分析发现了烟曲霉。此后，其他检查显示存在播散性曲霉病，并伴有骨关节破坏、血液和尿液播散。开始采用伏立康唑进行全身治疗，并结合关节内注射和手术清创，但患者最终死亡。烟曲霉引起的化脓性关节炎非常罕见，但在皮质类固醇注射后必须将其视为化脓性关节炎的鉴别诊断之一。其并发症可能非常严重且具有破坏性。
