A Case of Co-infection of the Knee Joint in an Older Kidney Transplant Recipient a Decade after Good Graft Function

A 71-year-old posttransplant diabetic female developed coinfection with Candida albicans, Carbapenem-resistant-Escherichia coli, and methicillin-resistant Staphylococcus aureus (MRSA) in the left knee joint following trauma due to a fall. Initially, we managed her with empirical oral antibiotics for 10 days. However, there was worsening of pain and swelling of the knee joint. Imaging and incision and drainage of the knee joint were done. We faced diagnostic challenges as the isolation of the fungus and MRSA were delayed. She was treated successfully with surgical drainage of the knee joint and appropriate therapy consisting of oral fluconazole for 6 weeks, intravenous tigecycline, and intravenous linezolid. Here, we discuss the dilemma in the diagnosis and the protracted course of the patient’s infection leading to complete resolution.