A case of Histoplasma capsulatum variety capsulatum septic arthritis successfully treated with surgery, systemic antifungals, and local amphotericin cement beads

Jocelyn Compton; Wyatt Vander Voort; Michael Willey; Poorani Sekar

doi:10.1016/j.ijid.2018.09.023

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A case of Histoplasma capsulatum variety capsulatum septic arthritis successfully treated with surgery, systemic antifungals, and local amphotericin cement beads

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A case of Histoplasma capsulatum variety capsulatum septic arthritis successfully treated with surgery, systemic antifungals, and local amphotericin cement beads

Jocelyn Compton, Wyatt Vander Voort, Michael Willey and Poorani Sekar

International journal of infectious diseases, Vol.77, pp.23-25

12/2018

DOI: 10.1016/j.ijid.2018.09.023

PMID: 30273649

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Abstract

•Bone and joint infections due to Histoplasma capsulatum variety capsulatum are rare.•Patients on methotrexate for rheumatoid arthritis may acquire H. capsulatum infections.•H. capsulatum septic arthritis of the shoulder is rare (common site is the knee).•Patients failing debridement and antifungals require local antifungal delivery. Histoplasma capsulatum variety capsulatum (H. capsulatum) is a thermally dimorphic fungus that is endemic to the Mississippi River and Ohio River valley regions. Of the hundreds of thousands of patients exposed to this fungus, less than 1% develop a severe illness most commonly manifesting as pulmonary disease. Septic arthritis from hematogenous seeding with H. capsulatum or from direct inoculation has been reported only rarely in the literature. The first case of septic arthritis of the shoulder due to H. capsulatum occurring in an immunocompromised patient, treated successfully with irrigation and debridement, systemic antifungals, and local delivery of amphotericin B with cement beads, is reported here. Importantly, the addition of local amphotericin B delivery by cement beads to conventional treatment likely led to clinical cure in this patient.

Antifungals

Histoplasma capsulatum

Fungal arthritis

Rheumatoid arthritis

Septic arthritis

Details

Title: Subtitle: A case of Histoplasma capsulatum variety capsulatum septic arthritis successfully treated with surgery, systemic antifungals, and local amphotericin cement beads
Creators: Jocelyn Compton - Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Wyatt Vander Voort - Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
Michael Willey - Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Poorani Sekar - Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Resource Type: Journal article
Publication Details: International journal of infectious diseases, Vol.77, pp.23-25
DOI: 10.1016/j.ijid.2018.09.023
PMID: 30273649
NLM abbreviation: Int J Infect Dis
ISSN: 1201-9712
eISSN: 1878-3511
Publisher: Elsevier Ltd
Language: English
Date published: 12/2018
Academic Unit: Infectious Diseases; Orthopedics and Rehabilitation; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984083276802771

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