Case Report: Olecranon Bursitis due to Prototheca wickerhamii in an Immunocompromised Patient

Abstract

Human protothecosis is a rare algal infection caused by Prototheca; it is a ubiquitous achlorophyllic alga, which rarely causes human disease. Currently, the pathogenesis remains unclear and no treatment options have been elucidated. We present a case of olecranon bursitis caused by Prototheca wickerhamii in an immunocompromised patient. A 45-year-old man presented with left elbow pain after scraping his elbow on a tree. He reported significant pain and swelling of the elbow after injury, which resolved without intervention. He was diagnosed with HIV/AIDS infection and started on antiretroviral therapy. Afterward, he experienced recurrent elbow swelling and pain; an incision and drainage was performed and cultures demonstrated P. wickerhamii. Unsuccessful treatment with oral voriconazole led to an attempt at therapy with parental amphotericin and oral doxycycline; however the patient left against medical advice. He presented to our facility and both parental amphotericin and doxycycline were initiated with planned outpatient bursectomy. He clinically improved on that regimen but left against medical advice before completing his recommended course of IV amphotericin and oral doxycycline. Patients diagnosed with disseminated protothecosis can have a mortality rate upward of 67%. Given the rarity of this pathogen, no official treatment guidelines exist and there are few studies analyzing the antimicrobial susceptibility of Prototheca. Management is challenging because of slow-growing nature of the algae, paucity of research studies, and limited susceptibility of this pathogen. This case adds to the limited body of literature by demonstrating the clinical presentation of protothecosis and highlighting the pathology and current treatment options.

Protothecosis in the mucosa of the pharynx mimicking pharyngeal cancer in an immunocompetent individual: a case report

“…Protothecosis has been classified into three types of clinical forms: cutaneous infections, olecranon bursitis, and disseminated infections. More than half of protothecosis cases are cutaneous infections [ 3 , 5 , 6 ]. The majority of cases occur in immunosuppressed individuals [ 3 , 4 ], while olecranon bursitis can occur in immunocompetent individuals after some types of penetrating trauma to the elbow [ 6 ].…”

“…More than half of protothecosis cases are cutaneous infections [ 3 , 5 , 6 ]. The majority of cases occur in immunosuppressed individuals [ 3 , 4 ], while olecranon bursitis can occur in immunocompetent individuals after some types of penetrating trauma to the elbow [ 6 ]. The main underlying conditions of protothecosis are local or systemic steroid use, hematologic malignancy or cancer, diabetes mellitus, acquired immunodeficiency syndrome, solid organ transplantation, alcoholism, and peritoneal dialysis [ 3 ].…”

“…Since the first case of human protothecosis in 1964, approximately 200 cases have been reported [ 2 – 4 ]. The clinical forms of protothecosis are classified into three types: cutaneous disease, olecranon bursitis, and disseminated disease [ 3 , 5 , 6 ]. More than half of the cases are cutaneous infections, and immunosuppression is a predisposing factor for human protothecosis [ 2 – 4 ].…”

Protothecosis in humans and animals

“…Objawy przy tej postaci zakażenia pojawiają się stopniowo, kilka tygodni po urazie i charakteryzują się lekkim stwardnieniem kaletki łokciowej. Przy dotyku łokieć jest tkliwy, widoczny jest rumień oraz wydzielający się surowiczo-krwisty płyn w zmiennych ilościach [4,24,25,26]. Ostatnią postacią prototekozy występującej u człowieka jest postać rozsiana lub ogólnoustrojowa.…”

The effect of Marma therapy in Student’s Elbow i.e., Olecranon Bursitis with special reference to Pain - A Single Case Study

“…However, diagnostic tests become very important when considering the risk of alternative diagnoses or the presence of infection. [8,9] As olecranon bursitis is an Inflammation of the olecranon bursa and triceps brachii tendon involving their attachment to the superior surface of the olecranon process of the ulna so it is Snayu (muscle & tendon), Asthi (bone) and Sandhi (joint) situated disease. In Ayurveda, Sushruta defined Marma as those points of the human body which cause fatality when injured are known as Marma.…”