Candida Parapsilosis Total Hip Arthroplasty Infection: Case Report and Literature Review

A 71 year-old male with a history of diabetes mellitus and right total hip arthroplasty (THA), received a revision surgery on the acetabulum cup of the THA because of loosening. The intraoperative culture yielded Candida parapsilosis. It was regarded as contamination initially. The patient had remained asymptomatic for 4 years after the revision surgery. The radiographs showed no evidence of loosening and the blood inflammatory markers were normal. The only abnormal finding was two subcutaneous swellings over the surgical scar. The patient then presented with right hip pain on walking and low-grade fever. A course of fluconazole had been given for 6 months, but the infection did not improve. Eventually, an excision arthroplasty of the right hip was performed. This case illustrates the rarity and the indolent pattern of presentation of fungal prosthetic infection. High index of suspicion and prompt treatment were needed. Literature on fungal prosthetic infection was also reviewed.

中文摘要一位七十一歲有糖尿病史的男仕因右全髋關節鬆脫接受髋臼杯修複手術。手術中的培養栽植出近平滑假絲酵母菌。起初它被當作是污染。病人在修複手術後的四年間並沒有病徵, X光檢查顯示沒有鬆脫的証據及血液發炎標記亦正常。唯一的異常是在疤痕處有兩個皮下腫脹。及後病人走路時有右臗關節痛的徵狀，並有輕微發燒。使用了六個月療程的口服氟康唑，但病情並沒有好轉。最後進行了右髖關節切除造形術。這個案說明了假體真菌感染是罕有的及其表徵是非常不明顯，高警覺性與迅速的治療是十分需要。我們也回顧了假體真菌感染的文獻。