Cryptococcus neoformans prosthetic joint infection: case report and review of the literature

Abstract

A 77-year-old woman with diabetes mellitus, myasthenia gravis and bilateral total hip arthroplasties underwent a two-stage procedure followed by treatment with vancomycin for a coagulase-negative staphylococcal prosthetic hip infection. This was complicated by a spontaneous left hip dislocation with a hematoma that was evacuated; all intraoperative cultures grew out Cryptococcus neoformans. Treatment with intravenous liposomal amphotericin B was started. Her prosthetic device was retained, and she was treated for 12 weeks, after which she was transitioned to fluconazole for long-term therapy. The hip remained stable 1 year out from her admission, and she retained mobility with the assistance of a walker. Fungi are an uncommon but potentially devastating cause of prosthetic joint infections, and most are due to Candida species. Cryptococcus neoformans is an ubiquitous yeast with worldwide distribution that generally causes infections in patients with major T cell immune deficiencies (e.g., HIV, transplantation and receipt of corticosteroids). Cryptococcal infections of native osteoarticular structures are uncommon, but have been well described in the literature. Data regarding cryptococcal prosthetic joint infections, however, are sparse.