Scedosporium prolificans Septic Arthritis and Osteomyelitis of the Hip Joints in an Immunocompetent Patient: A Case Report and Literature Review

Abstract

Scedosporium prolificans, also known as Scedosporium inflatum, is a fungus widespread in soil, sewage, and manure. This species is highly virulent and is an emerging opportunistic pathogen found in penetrating injuries in immunocompromised patients. Here we report on an immunocompetent patient with bilateral hip S. prolificans-associated osteomyelitis and septic arthritis caused by intentional penetrating trauma. The condition was refractory to initial antimicrobial suppression and surgical irrigation and debridement. Successful outcome was achieved after incorporating a bilateral two-stage total-hip-arthroplasty with Voriconazole-loaded cement and spacer.

Figure 1

Delayed-phase SPECT/CT displaying increased activity in the left AIIS extending to the superior acetabular rim.

Figure 2

T2 weighted MRI demonstrating a hyperintense focus in the left superior acetabular rim and hip effusion and capsular edema consistent with osteomyelitis and septic arthritis.

Figure 3

Postoperative radiograph demonstrating first-stage cemented total hip replacement with 48/32 mm Stryker RimFit Acetabular cup and size 9 Biomet Simplex cement spacer.

Figure 4

Plain radiograph showing progressive osteolysis of the superior right acetabular rim consistent with chronic infection.

Figure 5

Postoperative radiograph demonstrating bilateral first-stage cemented total hip replacement.