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Pseudotumor of the Hip due to Fungal Prosthetic Joint Infection

DOI: 10.1155/2013/502728

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Pseudotumors associated with total hip arthroplasty have been associated with metal-on-metal and metal-on-polyethylene total hip arthroplasties due to a granulomatous foreign-body reaction to methyl methacrylate, polyethylene, or metal ion release, but they have not been related to prosthetic joint infections. In this paper, we report an unusual case of Candida albicans total hip arthroplasty infection, causing a large inflammatory pseudotumor of the hip joint. Fungal periprosthetic joint infections are a rare clinical entity and difficult to diagnose, and a pseudotumor may be part of their clinical presentation. They should be suspected in immunodeficient host patients when clinical symptoms of prosthetic joint infections are observed. 1. Introduction Despite surgical advances and antibiotics evolution, periprosthetic infections still represent a challenge for orthopaedic surgeons because of the demanding surgical treatment and unpredictable clinical results. The most common pathogens involved in prosthetic joint infections are gram-positive Staphylococcal species bacteria followed by aerobic gram-negative Bacilli and Anaerobes species [1]. Fungal periprosthetic hip infections are rare, and clear and accepted treatment guidelines have not yet been established. Few case reports and limited clinical series have been published in the literature about this topic, and from the analysis of the available data only 21 patients with total hip arthroplasty, who were affected by fungal infections of joint prostheses, have been detected by Azzam et al. until 2009 [2]. Candida albicans was recognised as the responsible pathogen in 11 cases; others included Candida species such as Parapsilosis, Glabrata, and Tropicalis in 10 cases. Recently, 4 further cases of fungal periprosthetic hip infection due to Candida species pathogens have been reported by Anagnostakos et al. [3]. Fungal pathogens, other than Candida, have been reported only in a case of periprosthetic hip infection caused by Rhodotorula minuta [4]. In this paper, we report an atypical case of Candida albicans total hip arthroplasty infection, causing an inflammatory pseudotumor of the hip joint. To our knowledge, this is the first case reported in the literature in which such kind of clinical finding was identified in periprosthetic fungal infection of the joints. 2. Case Presentation In 2010, a 70-year-old Caucasian woman was referred by an infectious disease specialist to the Bone and Joint Infection Unit of our Orthopaedic Department because of a Candida albicans periprosthetic infection of the left

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