RESUMO
INTRODUCTION: Coccidioidomycosis is a fungal infection endemic to the Southwestern United States, Mexico, and South America. While uncommon, inhalation of spores or direct cutaneous contact can lead to disseminated infection in the immunocompetent, with the involvement of the musculoskeletal and integumentary systems. CASE REPORT: A 49-year-old patient with a history of pulmonary coccidioidomycosis presented with the right knee pain and multiple symptomatic abscesses beneath the suprapatellar and infrapatellar fat pads. Arthrocentesis and culture confirmed the infection, and open synovectomy, arthrotomy, and drainage of the infection were performed without complication. CONCLUSION: Disseminated coccidioidomycosis is an uncommon fungal infection that may involve joints and become refractory to pharmacotherapy. Management may require surgical intervention, along with infectious disease consultation and close follow-up. Patients from endemic regions should be evaluated with a comprehensive history of this disease.
RESUMO
A 46-year-old male with bilateral metal-on-metal hip prostheses presented with a left periprosthetic hip infection, as well as chronic, progressive osteolysis of the proximal femur and acetabulum with pelvic erosion. Three years before, the bearing surface was changed to metal-on-polyethylene prosthesis during an attempted revision but was complicated by extensive blood loss. At our institution, gross inspection demonstrated a soft-tissue hip mass of unknown etiology. Open biopsy and culture were performed, but extensive hemorrhaging required interventional radiology. Cultures revealed Clostridium septicum infection-known for its associations with gastrointestinal malignancy. Workup in the hospital was negative for malignancy, and definitive management was left hip disarticulation and intravenous antibiotics. The patient developed a chronic wound on the left hip incision but was ultimately lost to follow-up.
