Vergison Laurence, Schepens Alexander, Liekens Koen, De Kesel Renata, Van der Bracht Hans, Victor Jan
Department of Orthopaedic Surgery and Traumatology, General Hospital St-Lucas, Ghent, Belgium; Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
Department of Orthopaedic Surgery and Traumatology, General Hospital St-Lucas, Ghent, Belgium.
Int J Surg Case Rep. 2020;69:72-75. doi: 10.1016/j.ijscr.2020.03.037. Epub 2020 Mar 31.
Fungal periprosthetic joint infection (PJI) is a disruptive and complex complication of joint arthroplasty. We present a case of a fungal PJI with Candida parapsilosis after a total hip arthroplasty (THA).
A 73-year-old woman with a history of ovarian cancer with peritoneal metastases, was treated with a THA, due to symptomatic arthritis of the right hip. One month after surgery, she had difficulties walking. Inflammatory parameters were mildly increased. Aspiration of a subcutaneous abscess diagnosed Candida parapsilosis. A two-stage revision arthroplasty without spacer was performed. During a six-week prosthesis-free interval, intravenous fluconazole 400 mg was given. After reimplantation, fluconazole was continued for two weeks intravenously and life-long perorally. Follow-up of the patient after six months showed no recurrence of infection.
This case revealed that when PJI is suspected, a low treshold for joint aspiration is important. Two-stage revision with systematic antifungal therapy is the preferred treatment of fungal PJI. Our case demonstrated a good result with a prosthesis-free interval. Fluconazole is the preferred antifungal treatment and it should be applied for at least six months or longer.
To our knowledge, this is the first case of a fungal PJI with Candida parapsilosis after a THA treated with a two-stage revision arthroplasty without spacer and a life-long fluconazole treatment.
真菌性人工关节周围感染（PJI）是关节置换术一种具有破坏性且复杂的并发症。我们报告一例全髋关节置换术（THA）后发生近平滑念珠菌引起的真菌性PJI病例。
一名73岁女性，有卵巢癌伴腹膜转移病史，因右髋关节症状性关节炎接受THA治疗。术后1个月，她行走困难。炎症指标轻度升高。皮下脓肿穿刺抽吸确诊为近平滑念珠菌。进行了无间隔物的两阶段翻修关节成形术。在六周的无假体间隔期内，静脉给予氟康唑400mg。重新植入后，静脉持续给予氟康唑两周，并终身口服。六个月后对患者进行随访，未发现感染复发。
该病例表明，当怀疑有PJI时，对关节进行穿刺抽吸的阈值要低，这一点很重要。两阶段翻修联合系统性抗真菌治疗是真菌性PJI的首选治疗方法。我们的病例显示无假体间隔期取得了良好效果。氟康唑是首选的抗真菌治疗药物，应至少应用六个月或更长时间。
据我们所知，这是首例THA后发生近平滑念珠菌引起的真菌性PJI，采用无间隔物的两阶段翻修关节成形术及终身氟康唑治疗的病例。
