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Aspergillus arthritis and organ transplantation.

Figuères ML, Cantarovich D, Tattevin P, Le Pogamp P, Polard JL, Stock N, Blancho G - Clin Kidney J (2012)

Bottom Line: Treatment with voriconazole along with hip replacement led to complete recovery.However, drug interaction between immunosuppressive and anti-fungal drugs was complicated by cellular acute graft rejection.Aspergillus fumigatus arthritis is an uncommon and serious infection that should be evoked especially in the case of resistance to anti-microbial antibiotics and/or an atypical clinical picture.

View Article: PubMed Central - PubMed

Affiliation: Institut of Transplantation - Urology - Nephrology (ITUN), Hôtel Dieu. CHU de Nantes, France.

ABSTRACT
We report a case of a kidney and pancreas transplanted patient, hospitalized for septic hip arthritis. The whole diagnostic work-up including synovial and bone biopsies remained negative. After inefficient empirical anti-bacterial antibiotic treatment, femoral head resection was performed and tissue analysis revealed Aspergillus fumigatus hyphae. Treatment with voriconazole along with hip replacement led to complete recovery. However, drug interaction between immunosuppressive and anti-fungal drugs was complicated by cellular acute graft rejection. Aspergillus fumigatus arthritis is an uncommon and serious infection that should be evoked especially in the case of resistance to anti-microbial antibiotics and/or an atypical clinical picture.

No MeSH data available.


Related in: MedlinePlus

Initial (left) and 2 weeks later (right) X-rays: the circle around the radiological image indicates the crescentic radiolucent zone on the femoral head that led to continue with further examination.
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fig1: Initial (left) and 2 weeks later (right) X-rays: the circle around the radiological image indicates the crescentic radiolucent zone on the femoral head that led to continue with further examination.

Mentions: Hip radiographs were normal on admission but revealed a crescentic radiolucent zone on the femoral head when repeated 2 weeks later (Figure 1). Technetium Tc 99-labelled bone scintigraphy revealed an increased uptake at the coxo-femoral joint and ruled out aseptic bone necrosis (Figure 2). Ultrasound-guided synovial biopsy was performed, but no pathogen was found despite specific staining and culture medium for bacteria, mycobacteria and fungi. Histology revealed chronic, non-specific, inflammatory changes with lymphocytic infiltrates and fibrosis. Despite empirical anti-bacterial treatment with a combination of ceftriaxone and fosfomycin, the patient remained febrile and pain increased. Computed tomography (CT) scan-guided synovial and bone biopsies yielded no pathogen. Histology was again non-contributive.


Aspergillus arthritis and organ transplantation.

Figuères ML, Cantarovich D, Tattevin P, Le Pogamp P, Polard JL, Stock N, Blancho G - Clin Kidney J (2012)

Initial (left) and 2 weeks later (right) X-rays: the circle around the radiological image indicates the crescentic radiolucent zone on the femoral head that led to continue with further examination.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400502&req=5

fig1: Initial (left) and 2 weeks later (right) X-rays: the circle around the radiological image indicates the crescentic radiolucent zone on the femoral head that led to continue with further examination.
Mentions: Hip radiographs were normal on admission but revealed a crescentic radiolucent zone on the femoral head when repeated 2 weeks later (Figure 1). Technetium Tc 99-labelled bone scintigraphy revealed an increased uptake at the coxo-femoral joint and ruled out aseptic bone necrosis (Figure 2). Ultrasound-guided synovial biopsy was performed, but no pathogen was found despite specific staining and culture medium for bacteria, mycobacteria and fungi. Histology revealed chronic, non-specific, inflammatory changes with lymphocytic infiltrates and fibrosis. Despite empirical anti-bacterial treatment with a combination of ceftriaxone and fosfomycin, the patient remained febrile and pain increased. Computed tomography (CT) scan-guided synovial and bone biopsies yielded no pathogen. Histology was again non-contributive.

Bottom Line: Treatment with voriconazole along with hip replacement led to complete recovery.However, drug interaction between immunosuppressive and anti-fungal drugs was complicated by cellular acute graft rejection.Aspergillus fumigatus arthritis is an uncommon and serious infection that should be evoked especially in the case of resistance to anti-microbial antibiotics and/or an atypical clinical picture.

View Article: PubMed Central - PubMed

Affiliation: Institut of Transplantation - Urology - Nephrology (ITUN), Hôtel Dieu. CHU de Nantes, France.

ABSTRACT
We report a case of a kidney and pancreas transplanted patient, hospitalized for septic hip arthritis. The whole diagnostic work-up including synovial and bone biopsies remained negative. After inefficient empirical anti-bacterial antibiotic treatment, femoral head resection was performed and tissue analysis revealed Aspergillus fumigatus hyphae. Treatment with voriconazole along with hip replacement led to complete recovery. However, drug interaction between immunosuppressive and anti-fungal drugs was complicated by cellular acute graft rejection. Aspergillus fumigatus arthritis is an uncommon and serious infection that should be evoked especially in the case of resistance to anti-microbial antibiotics and/or an atypical clinical picture.

No MeSH data available.


Related in: MedlinePlus