Histoplasmosis diagnosed after arthroscopy of the knee: case report

Abstract

Fungal arthritis is a rare complication of arthroscopic surgeries, but its possibility should always be considered due its deleterious effects on any joint. Infection caused by the fungus Histoplasma capsulatum is the most common cause of respiratory tract infections by fungi, meanwhile histoplasmosis arthritis is more rare than all other fungal infections. However, their atypical forms of arthritis and the importance of early diagnosis and treatment cannot be over-emphasized. Herein we report a case of knee monoarthritis in an immunocompetent patient with histoplasmosis arthritis following an arthroscopic meniscetomy, diagnosed by synovial biopsy and culture performed during a second arthroscopic procedure. The joint was debrided in this second intervention and the patient received itraconazole initially and fluconazole latter on. The arthritis subsided after 10 months of treatment.

Fungal Infection Post Arthroscopic Meniscal Repair: A Rare Complication

“…Post-operative mycotic skeletal surgical site infections are rare and such infections after arthroscopic surgeries are even rarer [4][5][6][7][8]. The patients present with local signs of inflammation and fever which are insidious.…”

“…Infection due to fungal organisms is even rarer and difficult to diagnose due to their insidious nature and chronic presentation but when neglected has devastating consequences. Only a handful of such complications involving fungal organisms have been described post-arthroscopic procedures [3][4][5][6][7][8]. Here we present an immunocompetent young adult who underwent arthroscopic medial meniscal repair and presented with postoperative fungal infection.…”

Histoplasma capsulatum periprosthetic knee infection complicated by autoimmune-mediated systemic inflammatory response syndrome

“…Periprosthetic knee infection due to Histoplasma capsulatum is rare (ranking 10th in the order of frequency among all fungal PJIs) [4] . Plain radiographs can help identify chronic infections where implant loosening becomes obvious [7] .…”

“…Plain radiographs can help identify chronic infections where implant loosening becomes obvious [7] . Serology, joint aspiration, and culture are necessary to make the diagnosis according to the MSIS criteria [4] , [7] . Two-stage reconstruction for chronic PJI has shown good success [5] , [7] , [8] .…”

“…There have been a handful of case reports on periprosthetic joint infection (PJI) due to Histoplasma capsulatum [3] , [4] , [5] . In the current article, we review the rare occurrence of an immune-mediated systemic inflammatory response syndrome (SIRS) caused by Histoplasma capsulatum knee PJI.…”