Arthrographis kalrae prosthetic joint infection: case report and review of the literature

Arthrographis kalrae is a saprophytic fungus with initially yeast-like colonies, eventually developing hyphae and distinctive cylindrical arthroconidia. A. rarely associated human infection. This study reports the first case of prosthetic joint A 75-year-old male background type 2 diabetes, obesity total knee replacement underwent debridement polyliner exchange for chronic methicillin-resistant Staphylococcus aureus (MRSA) He was treated vancomycin 6 weeks oral trimethoprim/sulfamethoxazole (SXT) 18 months. Although wound remained intact, inflammation progressed after cessation SXT. First stage revision revealed loose femoral tibial components, patellar bone defects, turbid synovial fluid. Histology demonstrated small branching but no neutrophils. MRSA not isolated however cultures from multiple specimens grew fungus. The isolate referred to National Mycology Reference Centre (NMRC) confirmation susceptibility testing, where morphological features were consistent spp. confirmed using Bruker Biotyper MALDI-ToF MS (Score 2.28). Liposomal amphotericin followed by voriconazole terbinafine given in conjunction repeated voriconazole-infused cement. review literature implications fungal infection will be discussed.