Dual Organism Periprosthetic Joint Infection Following Total Knee Arthroplasty: A Case Report and One Year Follow-Up

Abstract

Abstract Periprosthetic joint infections (PJI) of the knee are mostly due to a single organism, very rarely, it is due to dual organisms, and even rarer are dual Gram-negative bacilli and fungal infections. Most fungal infections are caused by Candida albicans; however, very few case reports are available for nonalbicans Candida in immunocompetent patients. We report an unusual case of nonalbicans Candida infection with Gram-negative bacilli in the knee joint with no predisposing risk factors. A 59-year-old man reported following mild pain, swelling, and restricted knee movements in a case of a primary total knee arthroplasty. The patient had minimal symptoms but had gross lysis around implants on imaging. His inflammatory markers were significantly high and knee aspiration was turbid, with raised polymorphs without any conclusive staining result. The culture reports revealed a fungal and Gram-negative organism infection. The patient was managed by debridement, prosthesis removal and antibiotic-loaded cement spacer insertion, and culture-specific antibiotics, followed by revision TKA and oral fluconazole therapy. The patient had a good clinical performance at 3 months and 1-year follow-up visits, with a painless range of motion of 10°–90° and there was no evidence of recurrence of infection. Dual Gram-negative and fungal prosthetic joint infection is a rare but serious complication. In the presence of mild clinical symptoms, but extensive lysis around the implant, fungal pathology should be considered irrespective of the immune status of the patient.