Abstract
BackgroundWith improving surgical techniques for total elbow arthroplasty clinical outcomes have improved and its utilization continues to increase. Despite these advances, complication rates remain as high as 24%. Of these complications periprosthetic joint infection is one of the most common and morbid. The rheumatoid elbow remains a leading indication for total elbow arthroplasty. Patients with this condition frequently require immunosuppressive therapy, which places them at higher risk of both typical and atypical infections.Case presentationWe present the case of a persistent, late-onset periprosthetic joint infection in a total elbow arthroplasty of a 64-year-old Caucasian woman with severe refractory rheumatoid arthritis. The offending pathogen, Aspergillus terreus, is previously unreported in the arthroplasty literature and grew concurrently with coagulase-negative staphylococcus. Eradication of the fungal and bacterial agents involved resection arthroplasty, serial debridement, and multiple courses of intravenous and oral antimicrobial therapy. Two attempts at reimplantation arthroplasty failed to eliminate the infection and our patient ultimately required definitive resection arthroplasty.ConclusionsArthroplasty in the rheumatoid elbow confers with it a high complication rate. Inflammatory disease and immunosuppressive drugs combined with the subcutaneous anatomy of the elbow contribute to the risk of infection. Fungal periprosthetic joint infection in the rheumatoid patient presents both diagnostic and therapeutic challenges. Fungal growth should always be treated and requires organism-specific antimicrobials in conjunction with surgical debridement. More literature is needed to determine the optimal treatment regimen for this devastating complication.
Highlights
With improving surgical techniques for total elbow arthroplasty clinical outcomes have improved and its utilization continues to increase
Arthroplasty in the rheumatoid elbow confers with it a high complication rate
Fungal periprosthetic joint infections (PJI) in total elbow arthroplasty (TEA) are different from both bacterial PJIs in TEA, and fungal PJIs in hip and knee arthroplasty
Summary
Fungal PJIs in TEA are different from both bacterial PJIs in TEA, and fungal PJIs in hip and knee arthroplasty. Even though improved medical treatment in RA may have contributed to a decreased incidence of rheumatoid elbow as an indication for TEA [6], patients who do undergo the procedure for this indication may be at higher risk of atypical PJIs caused by fungi. A lack of literature on this rare but morbid complication left the responsible team without a precedent on which to base treatment. In this case, fungal infection of a TEA for rheumatoid elbow proved to be an extremely difficult complication to manage and caused considerable morbidity to the patient.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
