Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature.

March 18, 2017 at 10:42 am

Case Rep Infect Dis. 2017;2017:8682354. doi: 10.1155/2017/8682354. Epub 2017 Feb 9.

Ingraham NE1, Schneider B2, Alpern JD3.

Author information

1 Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.

2 Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

3 Department of Infectious Disease, University of Minnesota, Minneapolis, MN, USA.

Abstract

Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322427/pdf/CRIID2017-8682354.pdf

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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Biología Molecular, Epidemiología, HIC no SIDA, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Metodos diagnosticos, Micobacterias, REPORTS, REVIEWS, Sepsis, Update.

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