Bury my axe in wounded knee: A case of native knee septic arthritis caused by multidrug resistant Lomentospora prolificans

A 39-year-old male presenting with swelling and pain in the left knee after traumatic injury was diagnosed with rapidly progressive septic arthritis of the knee due to pan-resistant <i>Lomentospora prolificans</i>. While <i>L. prolificans</i> is an environmental mold, it infrequently causes infection in immunocompetent patients. These hosts most commonly suffer soft tissue or osteoarticular infections following direct, often traumatic inoculation, as opposed to the disseminated infection seen in patients with profound immunocompromise. This report describes a case of osteoarticular infection following traumatic inoculation in an immunocompetent host. Following several unsuccessful attempts at repeated incision and drainage alongside salvage antifungal therapy, the patient was successfully treated with olorofim, a novel investigational antifungal agent.