Document Type

Conference Proceeding

Publication Date

5-2-2025

Abstract

Introduction: We present a rare case of septic arthritis caused by Lodderomyces elongisporus, a yeast rarely implicated in human infections. This case highlights the diagnostic challenges and management strategies for fungal septic arthritis in an immunocompromised patient. Case Presentation: A 63-year-old African American woman with a complex medical history, including chronic heart failure (CHF), hypertension, end-stage renal disease (ESRD) on hemodialysis, severe protein-energy malnutrition on total parenteral nutrition, duodenal switch with malabsorption, deep vein thrombosis (DVT) on warfarin, and previous sepsis episodes, presented with worsening dyspnea. She was admitted in August 2024 for acute-on-chronic CHF exacerbation. During her admission, she developed progressive left knee swelling and pain, prompting evaluation for suspected septic arthritis. During a prior hospitalization from June to July of 2024, the patient had bilateral knee pain. The knee pain was attributed to pseudogout since arthrocentesis revealed calcium pyrophosphate crystals. Corticosteroid injections provided minimal relief. Cultures from her left knee revealed WBC 29,850/mm3 and grew Lodderomyces elongisporus, which was dismissed as a contaminant. Clinical Course: Left knee arthrocentesis revealed 32,660 WBC/mm3, 20,000 RBC/mm3, and no crystals. Cultures again grew Lodderomyces elongisporus. Given the repeated isolation, a diagnosis of fungal septic arthritis was confirmed. Knee X-rays revealed moderate osteoarthritis in both knees with effusions. CRP decreased from 83.5 mg/L to 4.4 mg/L from July to October of 2024. ESR decreased from 89 mm/hr to 48 mm/hr from August to October of 2024. Blood cultures were repeatedly negative which ruled out systemic dissemination. Management: Orthopedic surgery performed washout and debridement of the left knee. Post-operative thrombectomy and transition to oral anticoagulation with apixaban were managed to address extensive DVTs. Infectious disease specialists prescribed intravenous micafungin 100 mg daily for six weeks, as echinocandins are considered first-line treatment for Lodderomyces elongisporus. Physical and occupational therapy were initiated to restore mobility. Discussion: This case underscores the rarity of fungal septic arthritis due to Lodderomyces elongisporus, an environmental yeast with limited virulence. Immunocompromised states such as ESRD, chronic malnutrition, and previous episodes of sepsis likely predisposed this patient to infection. Misinterpreting the initial culture isolation of Lodderomyces elongisporus as contamination delayed the diagnosis and subsequent treatment, underscoring the critical need to differentiate true infection from contaminants. This case illustrates the importance of repeated culture testing to confirm fungal arthritis, particularly in immunocompromised patients with atypical pathogens. Moreover, it highlights the challenges in managing rare fungal infections, including limited antifungal susceptibility data and established treatment protocols for Lodderomyces elongisporus. Surgical debridement, combined with prolonged antifungal therapy, remains the cornerstone of management in such cases. This report emphasizes the necessity for heightened clinical vigilance, meticulous diagnostic efforts, and a multidisciplinary approach in treating rare fungal infections in high-risk individuals. Further research is warranted to guide optimal management strategies for these uncommon yet significant infections.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2025 Resident and Medical Student Day, May 2, 2025, Troy, MI

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