Successful management of Lomentospora prolificans septic arthritis and osteomyelitis in an immunocompetent child: A case report

Abstract

Available online We report a case of limb-threatening Lomentospora prolificans elbow infection in a 3-year-old immunocompetent boy following a closed fracture. Resolution of infection was achieved following combined aggressive debridement, combined antifungal therapy, voriconazole-loaded bone cement, and antiseptic joint irrigation. This highlights the need for early diagnosis and multi-modal surgical, medical and other novel adjunctive therapies in managing these difficult-to-treat infections. Increased research and improved access to novel antifungal drugs are essential to enhance treatment options for intrinsically multidrug-resistant fungal infections.

Keywords: Osteomyelitis septic arthritis Lomentospora prolificans voriconazole paediatric.

Fig. 1

Serum voriconazole concentrations over the course of treatment.

Fig. 2

Right elbow septic arthritis and osteomyelitis due to Lomentospora prolificans in a 3-year-old boy: Imaging findings A: Magnetic resonance imaging (MRI) (sagittal) demonstrating moderate marrow oedema within the distal humeral metaphysis, with circumferential periosteal elevation and a hyperintense rind suggestive of periosteal reaction/granulation tissue. Cement seen within extensive osseous defects within the olecranon fossa. B: MRI (coronal, post-contrast) demonstrating marked synovitis with joint capsule distension, particularly at the medial/ulnar aspect and radial head. In addition, there is diffuse soft tissue oedema and moderate reactive lymphadenopathy along the medial neurovascular bundle and in the axilla C: X-ray (anteroposterior) demonstrating stable osseous defects in the capitellum and trochlea, with persistent smooth periosteal reaction. D: X-ray (lateral) demonstrating unchanged osseous defect with persistent periosteal reaction.