Infection in revised total knee arthroplasty due to Candida krusei. Successful treatment with voriconazole and staged reimplantation

Abstract

Fungal infections of total knee arthroplasty are extremely rare. Only a few cases have been reported in the literature. To our knowledge, this is the first case of infection caused by Candida krusei. The occurrence of C. krusei infection has increased since the early 1990s probably owing to the use of fluconazole, especially for fungal infection prophylaxis. The patient was successfully treated by two-stage revision and parenteral administration of voriconazole with a dosage of 6 mg/kg body weight (400 mg) two times in the first 24 h followed by 4 mg/kg body weight (200 mg) every 12 h for 6 weeks. At the time of second-stage surgical procedure, a distal femoral allograft was used in combination with a rotating hinge prosthesis due to a massive femoral bone defect. A collapse of the allograft and a fracture of the host cortical shell occurred 4 months after the operation necessitating a third revision with a megaprosthesis. At the latest follow-up 65 months after the infection, she had no sign of recurrence with a good functional result.