Difficult Diagnosis of Fungal Arthritis After Arthroscopic Anterior Cruciate Ligament Reconstruction

Abstract

Case: An 18-year-old woman underwent arthroscopic anterior cruciate ligament reconstruction (ACLR) but developed recurrent knee effusion. At age 25 years, her right knee pain worsened, and radiographs revealed extensive bone loss. She was diagnosed with fungal (Candida parapsilosis) osteomyelitis by synovial fluid cultures. She underwent 2-stage surgery involving an amphotericin B-loaded cement spacer implantation and bone defect grafting. No recurrence of infection has been noted for 3 years postoperatively. Conclusions: Fungal osteomyelitis may have few signs of local infection and often remains undiagnosed until bone loss occurs. Differential diagnosis should include this disease when there is recurrent knee effusion after ACLR.