Pediatric Fungal Septic Arthritis Following Intra-articular Administration of the Two-Month Vaccination: A Case Report

The majority of pediatric fungal septic arthritis patients are infants. Risk factors include prematurity and neonatal septicemia with prolonged hospitalization. Here, we present a case of a two-month-old male infant, preterm at 28 weeks and NICU graduate. He was transferred to King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia due to left hip septic Candida arthritis that was unresponsive to antifungal treatment in an outside hospital. Initially, he was administered the two-month scheduled vaccines inadvertently in the intra-articular space of the left hip. Three days later, he developed candidemia and symptoms of septic arthritis in the left hip. Joint aspiration grew Candida and he was then commenced on anti-fungal treatment. In our hospital, he was vitally stable and febrile. Examination showed erythema, warmth, and severe tenderness, with pain and reduced range of motion of the left hip. Inflammatory markers were increased. X-ray of the left hip was unremarkable. MRI with contrast showed mild left hip effusion associated with synovial enhancement and soft tissue edema and enhancement. Incision and drainage was done after which he received vancomycin and meropenem for four weeks along with fluconazole for eight weeks. A back slab was applied for four weeks. The patient achieved successful recovery upon completion of the treatment and incision and drainage. To our knowledge, this is the first reported case of fungal septic arthritis as a consequence of intra-articular vaccination administration. This case highlights the importance of considering fungi as an etiology of pediatric septic arthritis, particularly in patients with the aforementioned risk factors.