Fungal Periprosthetic Knee Joint Infection in a Patient with Metamizole-Induced Agranulocytosis

Sebastian Oenning, Cand Med; Burkhard Moellenbeck, MD; Georg Gosheger, MD; Tom Schmidt-Bräkling, MD; Jan Schwarze, MD; Thomas Ackmann, MD; Kristian Nikolaus Schneider, MD; Christoph Theil, MD

Arthroplasty Today (Dec 2020)

Fungal Periprosthetic Knee Joint Infection in a Patient with Metamizole-Induced Agranulocytosis

Sebastian Oenning, Cand Med,
Burkhard Moellenbeck, MD,
Georg Gosheger, MD,
Tom Schmidt-Bräkling, MD,
Jan Schwarze, MD,
Thomas Ackmann, MD,
Kristian Nikolaus Schneider, MD,
Christoph Theil, MD

Affiliations

Sebastian Oenning, Cand Med: Corresponding author. Muenster University Hospital, 48149 Muenster, North Rhine-Westphalia, Germany. Tel.: +4915772023995.; Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, North Rhine-Westphalia, Germany
Burkhard Moellenbeck, MD: Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, North Rhine-Westphalia, Germany
Georg Gosheger, MD: Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, North Rhine-Westphalia, Germany
Tom Schmidt-Bräkling, MD: Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, North Rhine-Westphalia, Germany
Jan Schwarze, MD: Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, North Rhine-Westphalia, Germany
Thomas Ackmann, MD: Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, North Rhine-Westphalia, Germany
Kristian Nikolaus Schneider, MD: Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, North Rhine-Westphalia, Germany
Christoph Theil, MD: Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, North Rhine-Westphalia, Germany

Journal volume & issue: Vol. 6, no. 4
pp. 726 – 730

Abstract

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We present the case of a 55-year-old female patient with metamizole-induced agranulocytosis after total knee arthroplasty, leading to septic periprosthetic joint infections (PJIs). Owing to metamizole-induced agranulocytosis, the synovial leukocyte count was negative. Here, we discuss the diagnostic challenges evolving from sepsis and neutropenia in patients with suspected PJIs. We suggest an urgent surgical approach, mainly focusing on the clinical presentation preoperatively. Later, our patient developed candidemia and periprosthetic tissue samples were positive for Candida albicans. For fungal PJIs, long-term follow-up studies are lacking and therapeutic recommendations differ. Here, we present our therapeutic approach, including staged revision and 12 weeks of systemic antifungal therapy, and discuss recent findings regarding the therapy of fungal PJIs.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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Abstract

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