Repetitive intra-articular therapy in fungal arthritis: Adjunct to systemic therapy in a patient with pediatric acute lymphoblastic leukemia

Invasive fungal infections are important causes of mortality and morbidity in immunodeficiencies, hematological malignancies, and transplant recipients. There is scarce information in the literature about the diagnosis, treatment methods, and management. Herein, a unique involvement site of invasive fungal infection caused by Aspergillus flavus in the nadir of the induction chemotherapy of a 13-year-old boy with the diagnosis of acute lymphoblastic leukemia is presented. Despite prolonged intravenous antifungal therapy, the patient exhibited an inadequate response. As a result, intra-articular antifungal treatment was implemented alongside curettage and joint space irrigation. These additional interventions led to significantly improved clinical outcomes. Since fungal osteomyelitis can be an important cause of mortality and morbidity in immunosuppressed patients, prompt diagnosis and multidisciplinary treatment are crucial.