Osteomyelitis Caused by Moesziomyces aphidis in an Immunocompetent Adult: A Case Report and Literature Review

TL;DR

A 19-year-old woman developed a rare fungal infection in her bone caused by Moesziomyces aphidis after a leg injury, marking the first known case in a healthy adult.

Contribution

First reported case of Moesziomyces aphidis osteomyelitis in an immunocompetent adult.

Findings

M. aphidis was identified through internal transcribed spacer sequencing after initial cultures failed.

The patient improved with a combination of amphotericin B and voriconazole.

The case highlights the need to consider Moesziomyces spp. in osteomyelitis diagnoses, even in healthy individuals.

Abstract

Osteomyelitis caused by Moesziomyces aphidis is exceedingly rare and, to our knowledge, has not been previously reported in immunocompetent individuals. This case represents the first documented instance. A 19-year-old woman developed osteomyelitis following an open right leg fracture sustained in a traffic accident. Initial cultures yielded an unidentified yeast, later identified as M. aphidis through internal transcribed spacer sequencing. The patient demonstrated clinical improvement with combination therapy of amphotericin B and following oral voriconazole. This case underscores the emerging pathogenic potential of Moesziomyces spp., particularly in the setting of trauma and open wounds, and highlights the importance of including this genus in the differential diagnosis of osteomyelitis. A literature review indicates that Moesziomyces infections are predominantly observed in immunocompromised patients, especially in Asia. However, our case underscores the need for greater awareness of this emerging pathogen in immunocompetent hosts as well.