A Case of Septic Hip Arthritis Caused by Aspergillus fumigatus in a Liver Transplant Recipient

Tark Kim; Sang-Rok Lee; Oh Hyun Cho; Ki Ho Park; Ryan Oh; Sang-Oh Lee; Yang Soo Kim; Jun Hee Woo; Mi-Na Kim; Sang-Ho Choi

doi:10.3947/ic.2008.40.3.170

Journal List > Infect Chemother > v.40(3) > 1075400

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Lee, Cho, Park, Oh, Lee, Kim, Woo, Kim, and Choi: A Case of Septic Hip Arthritis Caused by Aspergillus fumigatus in a Liver Transplant Recipient

Case Report

Infection and Chemotherapy

Infection and Chemotherapy 2008; 40(3): 170-174.

Published online: 20 June 2008

DOI: https://doi.org/10.3947/ic.2008.40.3.170

A Case of Septic Hip Arthritis Caused by Aspergillus fumigatus in a Liver Transplant Recipient

Tark Kim, M.D.¹, Sang-Rok Lee, M.D.¹, Oh Hyun Cho, M.D.¹, Ki Ho Park, M.D.¹, Ryan Oh, M.D.¹, Sang-Oh Lee, M.D.¹, Yang Soo Kim, M.D.¹, Jun Hee Woo, M.D.¹, Mi-Na Kim, M.D.², Sang-Ho Choi, M.D.¹

¹Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence: Sang-Ho Choi, M.D. Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-2 dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3300, Fax: +82-2-3010-6970, sangho@amc.seoul.kr

Received 17 September 2007 Accepted 28 February 2008

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Septic arthritis is an uncommon finding of invasive Aspergillosis. It can be caused by direct inoculation, post-surgical infection, and hematogenous spread. Articular aspergillosis often involves the knee. A 49-year-old man who received a liver transplant in China on two months ago, due to liver cirrhosis caused by hepatitis B virus was admitted because of left side hip pain. Hip MRI showed joint effusion and bony destruction of the left hip and acetabulum. Incision and drainage was done and Aspergillus fumigatus was isolated from the resected tissue. After eight weeks of amphotericin B therapy, total hip replacement arthroplasty was done. Oral itraconazole 400mg/day was prescribed for six months after operation. The patient is now doing well without physical restriction

Keywords: Aspergillus fumigatus, Infectious arthritis, Liver transplantation

Figures and Tables

Figure 1

Hip MRI (A) T1 and (B) T2 image showing the joint effusion of the left hip, minimal bony destruction of the left acetabulum, and myositis involving the adductor longus, gluteus minimus and medius, and iliacus muscles.

Figure 2

Left hip excisional biopsy (A : Hematoxylin-eosin staining; original magnification×100, B : Hematoxylin-eosin staining; original magnification×400) showing fibrous tissue with chronic inflammation and calcifications.

Table 1

Clinical Characteristics of Patients with Arthritis by Aspergillus in Reviewed Literatures

Abbreviation : Ref, reference; BMT, bone marrow transplantation

^*hyphae detected in specimen

References

1. Denning DW. Invasive aspergillosis. Clin Infect Dis. 1998. 26:781–803.

2. Denning DW, Stevens DA. Antifungal and surgical treatment of invasive aspergillosis : review of 2,121 published cases. Rev Infect Dis. 1990. 12:1147–1201.

3. Mekan SF, Saeed O, Khan JA. Invasive aspergillosis with polyarthritis. Mycoses. 2004. 47:518–520.

4. Steinfeld S, Durez P, Hauzeur JP, Motte S, Appelboom T. Articular aspergillosis : two case reports and review of the literature. Br J Rheumatol. 1997. 36:1331–1334.

5. Alvarez L, Calvo E, Abril C. Articular aspergillosis : case report. Clin Infect Dis. 1995. 20:457–460.

6. Panigrahi S, Nagler A, Or R, Wolf DG, Slavin S, Shapira MY. Indolent aspergillus arthritis complicating fludarabine-based non-myeloablative stem cell transplantation. Bone Marrow Transplant. 2001. 27:659–661.

7. Steinbach WJ, Stevens DA, Denning DW. Combination and sequential antifungal therapy for invasive aspergillosis : review of published In vitro and In vivo interactions and 6281 clinical cases from 1966 to 2001. Clin Infec Dis. 2003. 37:suppl 3. S188–S224.

8. Tack KJ, Rhame FS, Brown B, Thompson RC Jr. Aspergillus osteomyelitis. Report of four cases and review of the literature. Am J Med. 1982. 73:295–300.

9. Taillandier J, Alemanni M, Cerrina J, Le Roy Ladurie F, Dartevelle P. Aspergillus osteomyelitis after heart-lung transplantation. J Heart Lung Transplant. 1997. 16:436–438.

10. Faure BT, Biondj JX, Flanagan JP, Clarke R. Aspergillar osteomyelitis of the acetabulum. A case report and review of the literature. Orthop Rev. 1990. 19:58–64.

11. Cimerman M, Gunde-Cimerman N, Zalar P, Perkovic T. Femur osteomyelitis due to a mixed fungal infection in a previously healthy man. J Clin Microbiol. 1999. 37:1532–1535.

12. Kaneko J, Sugawara Y, Makuuchi M. Aspergillus osteomyelitis after liver transplantation. Liver Transpl. 2002. 8:1073–1075.

13. Stratov I, Korman TM, Johnson PD. Management of aspergillus osteomyelitis : Report of failure of liposomal amphotericin B and response to voriconazole in an immunocompetent host and literature review. Eur J Clin Microbiol Infect Dis. 2003. 22:277–283.

14. Kim SI, Kim YJ, Kim YR, Choi JY, Yoon SK, Moo IS, Kim DG, Lee MD, Kang MW. A case of multiple bone aspergillosis in liver transplant recipients : successful treatment with voriconazole at outpatient clinic. Infect Chemother. 2007. 39:Suppl 2. S407.

15. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R, Rubin RH, Wingard JR, Stark P, Durand C, Caillot D, Thiel E, Chandrasekar PH, Hodges MR, Schlamm HT, Troke PF, de Pauw B. Invasive Fungal Infections Group of the European Organisation for Research and Treatment of Cancer and the Global Aspergillus Study Group: Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002. 347:408–415.

TOOLS

Similar articles