Arthritis and osteomyelitis due to Aspergillus fumigatus: a 17 years old boy with chronic granulomatous disease

Abstract

Background: Invasive Aspergillus infections are frequently seen in immunocompromised patients but arthritis is a rare complication of Aspergillus infections in the absence of immune suppressive therapy, trauma or surgical intervention.

Case presentation: A 17 years old male patient with arthritis and patellar osteomyelitis of the left knee whose further investigations revealed chronic granulomatous disease as the underlying disease is followed. Aspergillus fumigatus was isolated from the synovial fluid and the tissue samples cultures. He was treated with Amphotericin B deoxicolate 0.7 mg/kg/day. Also surgical debridement was performed our patient. Amphotericin B nephrotoxicity developed and the therapy switched to itraconazole 400 mg/day. Itraconazole therapy were discontinued at the 6th month. He can perform all the activities of daily living including.

Conclusion: We think that, chronic granulomatous disease should be investigated in patients who have aspergillar arthritis and osteomyelitis.

Figure 1

Left knee radiograph for patient with Aspergillus arthritis and osteomyelitis. A lytic lesion of the patella.

Figure 2

MRI scan showed left knee arthritis, osteomyelitis and fistulated patellar osteomyelitis.

Figure 3

The synovial biopsy of the left knee expressed granulomatous lession due to Aspergillus.