Aspergillus fumigatus Septic Arthritis of the Wrist: A Report of a Rare Case in an Immunocompromised Patient

Abstract

Aspergillus fumigatus is a saprophytic fungus encountered as a pathogen in airborne lung infections. Although it commonly causes pulmonary infectious diseases, when disseminated, it may cause a systemic infection termed invasive aspergillosis, which is associated with high mortality and morbidity. Virtually, all organ systems may be involved. However, the musculoskeletal system is relatively uncommon. Here, we present a case of invasive aspergillosis in an immunocompromised patient involving the wrist joint, an exceedingly rare site. Our treatment choice is serial open debridement, irrigation, and intravenous antibiotics. This case study exemplifies the potential challenges in the identification and treatment of such an uncommon clinical condition. A thorough clinical and microbiological evaluation is essential for accurate diagnosis of fungal septic arthritis of the wrist. Aggressive early surgical treatment combined with appropriate early intravenous antibiotics is crucial for eradicating joint infection.

Keywords: aspergillus fumigatus; carpectomy; invasive aspergillosis; non-hodgkin lymphoma (nhl); wrist septic arthritis.

Figure 1. Preoperative hand anteroposterior X-ray image demonstrates osteolysis of the carpal bones.

Diffuse osteolytic changes in the carpal bones in the region inside the red circle of the hand anteroposterior X-ray image are noteworthy.

Figure 2. MRI demonstrates wrist joint effusion and bone marrow edema of the carpal bones.

Wrist joint effusion and bone marrow edema in the carpal bones in the region inside the red circle are noteworthy. The white areas around the joint indicate the joint effusion. The orange star illustrates the bone marrow edema in the carpal bones. MRI: magnetic resonance imaging

Figure 3. Intraoperative image during the open debridement and irrigation of the wrist joint. Purulent material was spontaneously drained out of the joint cavity following the arthrotomy.

Figure 4. Microscopic evaluation of the joint fluid specimen.

May-Grünwald-Giemsa stain showing polymorphonuclear leukocytes, synovial cells, and Aspergillus hyphae.

Figure 5. Microscopic evaluation of the joint fluid specimen.

Lactophenol cotton blue stain demonstrating Aspergillus fumigatus.