Fungal Prosthetic Joint Infection by Candida parapsilosis After Total Knee Arthroplasty

TL;DR

A rare case of fungal infection in a prosthetic knee joint caused by Candida parapsilosis was successfully treated with a two-stage revision and antifungal therapy.

Contribution

This case report presents a successful treatment approach for fungal prosthetic joint infection with a shorter interval and antifungal-impregnated spacer.

Findings

Fungal infection by Candida parapsilosis was diagnosed through synovial fluid and tissue analysis.

A two-stage revision with a 4-week interval and antifungal spacer led to a favorable outcome.

Prolonged antifungal therapy with fluconazole was effective in managing the infection.

Abstract

Total knee arthroplasty is an increasingly common surgical intervention for degenerative knee disease, yet it carries a risk of prosthetic joint infection (PJI). While bacterial infections dominate the landscape of PJIs, fungal infections represent a rare but significant concern, especially in immunocompromised patients. This case report describes a 71-year-old patient who presented in October 2024 with left knee pain and swelling 7 months after total knee arthroplasty. A prosthetic joint infection due to Candida parapsilosis was diagnosed preoperatively by repetitive microbiological examination of synovial fluid and intraoperatively by tissue samples and sonication of prosthetic material. A two-stage revision surgery with a short 4-week interval was performed using an antifungal-impregnated spacer, followed by 6 months of systemic antifungal treatment with fluconazole and continued by fluconazole suppressive treatment for another 6 months. A favorable clinical and functional outcome was achieved after 11 months of follow-up. This is a rare case of fungal PJI treatment with a two-stage revision with a shorter interval, using an antifungal impregnated spacer combined with a prolonged antifungal therapy.

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