Refractory Arthrographis kalrae native knee joint infection

Abstract

Rare reports of infection with Arthrographis kalrae have often demonstrated a protracted clinical course. We describe refractory infection of the native knee with Arthrographis kalrae after a penetrating injury and Yttrium synovectomy, finally controlled with two stage joint revision and combination antifungal therapy. The paucity of worldwide data about such uncommon invasive fungal infections contributes to the diagnostic and therapeutic challenges of these cases.

Keywords: Arthrographis; Arthrographis kalrae.

Fig. 1

(a) Culture appearance of the knee isolate at 48 h incubation in 36 °C on Sabouraud agar supplemented with chloramphenicol. (b) Microscopy (with lactophenol cotton blue stain) from a 48 h-old colony of organism isolated from the knee, demonstrating oval shaped budding yeast-like cells.

Fig. 2

Culture appearance of the knee isolate at 7 days incubation on Sabouraud agar supplemented with chloramphenicol.

Fig. 3

(a) Microscopy from slide culture of the knee isolate demonstrating hyaline septate hyphae with conidiophores branched in a dendritic pattern and producing chains of one-celled arthrospores without disjunctor cells. (b) Microscopy from slide culture of the knee isolate demonstrating formation of single conidia, often on a short pedicle.