Mycobacterium avium Complex Septic Arthritis Presenting as Osteonecrosis of the Femoral Head in a Patient With Systemic Lupus Erythematosus

Abstract

Mycobacterium avium complex is a rare cause of musculoskeletal infection, usually occurring in patients with compromised immune systems. Obtaining the diagnosis requires a high index of suspicion, and treatment can be delayed because of difficulty with isolating the organism. Treatment involves prolonged, targeted combination antibiotic therapy, and it is unclear whether eradication of the infection can occur in the presence of a foreign body, such as antibiotic spacers. The authors report a case of M avium infection presenting as presumed osteonecrosis of the femoral head in a young woman with systemic lupus erythematosus. She presented with collapse of her femoral head coinciding with several months of progressive, debilitating hip pain. She had mild fevers during that time, but results from multiple infectious workups, including hip aspiration, were negative. Purulent fluid was found in the operating room, but diagnosis was delayed for 5 weeks while waiting for cultures. The patient required 3 subsequent operations, eventually being left with a resection arthroplasty. Pertinent issues concerning diagnosis, therapy, and treatment challenges in M avium infections of the musculoskeletal system are discussed in this case report. [Orthopedics. 2017; 40(3):e549-e552.].

Clinical evaluation of total hip arthroplasty for osteoarthropathy secondary to septic hip arthritis

“…[10] Patients often experience long-term hip discharge, protracted sinus tracts, are often accompanied by hip joint stiffness and limb shortening, and eventually lead to secondary hip arthritis, which seriously affect the patient’s quality of life. [11] Thus, patients hope to improve hip function and quality of life.…”

Mycobacterium avium complex prosthetic joint infection: A systematic review of the literature and pooled analysis

“…Since the 1990s, MAC infections of hip and knee joints were increasingly identified in the setting of AIDS. 11,22,23 More recently, various comorbid conditions and multi-organ diseases leading to compromised immune system have been acknowledged as a contributing risk factor for septic arthritis and periprosthetic infections by MAC. 24 According to our review, the most of the patients (16/17 patients, 94.1%) were noted to have underlying medical condition(s) that might have affected immunity similar to other studies.…”

“…The exclusion criteria were (1) articles without data on patient risk factors for infection (immunocompromising conditions), (2) assessment of any other joints beyond the realm of the hip and knee joint, 10 (3) non-English articles, (4) abstracts only, (5) conference presentations, and (6) native joint infection (septic arthritis) before arthroplasty. 11,12 Given the dearth of substantial evidence pertaining to this topic, our review predominantly encompasses case reports and case series to provide a comprehensive analysis. No limits for the minimum duration of follow-up for patient cohorts in each study were imposed.…”