Fungal Periprosthetic Joint Infection Caused By Trichoderma

Introduction Fungal periprosthetic joint infection is considered atypical and occurs in around 1-2% of all periprosthetic joint infections [1]. Trichoderma, known for its pathogenic potential in immunocompromised hosts [2], has been documented to cause lethal infections in various organ systems before [3,4,5]. However, this report delineates a novel occurrence of Trichoderma-induced bone infection. Case Presentation A 63-year-old immunocompromised woman underwent left hip total arthroplasty in April 2023. In October, the patient developed a periprosthetic joint infection attributable to Staphylococcus epidermidis, necessitating a two-stage surgical approach. The infection was initially treated with vancomycin in conjunction with trimethoprimsulfamethoxazole. Upon completion of the second stage in November, vancomycin therapy was maintained, followed by the subsequent initiation of rifampicin and levofloxacin. Three weeks post-second stage, the growth of Trichoderma in two tissue samples obtained intraoperatively prompted an international multidisciplinary discussion, which resulted in the initiation of antifungal therapy. The administration of amphotericin B was commenced, but due to the patient's intolerance, treatment had to be discontinued after 8 days, leaving rifampicin and levofloxacin as the remaining therapeutic regimen. At the three-month post-operative assessment, the patient remained in satisfactory health with no reported issues. Discussion Trichoderma growth in two consecutive tissue samples obtained intraoperatively resembles clear clinical evidence of a fungal periprosthetic joint infection. Despite an incomplete antifungal therapy course, leaving only broad spectrum antibiotics in continued use, the patient shown no signs of infection at the three-month postoperative follow-up visit, that could suggest that the Trichoderma growth was an instance of contamination. Conclusions Trichoderma infections are seldom observed, yet can exhibit severe and perilous clinical manifestations in patients with immunodeficiency. In this particular instance, the patient demonstrated clinical evidence of a Trichoderma infection presenting in bone.