# Bury my axe in wounded knee: A case of native knee septic arthritis caused by multidrug resistant Lomentosporaprolificans

## TL;DR

A 39-year-old man developed a rare fungal knee infection after a traumatic injury and was successfully treated with a new antifungal drug.

## Contribution

First reported case of Lomentospora prolificans septic arthritis treated successfully with olorofim in an immunocompetent patient.

## Key findings

- L. prolificans caused septic arthritis in an immunocompetent patient following traumatic injury.
- Olorofim, a novel antifungal agent, successfully treated the infection after other therapies failed.

## Abstract

A 39-year-old male presenting with swelling and pain in the left knee after traumatic injury was diagnosed with rapidly progressive septic arthritis of the knee due to pan-resistant Lomentospora prolificans. While L. prolificans is an environmental mold, it infrequently causes infection in immunocompetent patients. These hosts most commonly suffer soft tissue or osteoarticular infections following direct, often traumatic inoculation, as opposed to the disseminated infection seen in patients with profound immunocompromise. This report describes a case of osteoarticular infection following traumatic inoculation in an immunocompetent host. Following several unsuccessful attempts at repeated incision and drainage alongside salvage antifungal therapy, the patient was successfully treated with olorofim, a novel investigational antifungal agent.