Prosthetic Knee Joint Infection Caused by Mycobacterium kansasii. J Am Acad Orthop Surg Glob Res Rev 2022 Apr 07;6(4)
Date
04/08/2022Pubmed ID
35389898Pubmed Central ID
PMC8994076DOI
10.5435/JAAOSGlobal-D-21-00183Scopus ID
2-s2.0-85134440534 (requires institutional sign-in at Scopus site) 1 CitationAbstract
Mycobacterium kansasii is a nontuberculous mycobacterium that is a rare cause of prosthetic joint infections (PJIs). This case report presents a 58-year-old man who developed rapidly progressive arthritis after exposing his right knee to an unknown fluid at a microbial pharmaceutical company. Within a year, he underwent a right total knee arthroplasty (TKA). At 5 months postoperatively, he presented with pain and swelling of that knee. Imaging revealed extensive periprosthetic osteolysis with diffuse intracapsular and posterior extracapsular fluid collections. Multiple knee aspirates had negative cultures, and infectious laboratory test results were equivocal. Two years after his primary arthroplasty, the patient underwent posterior débridement and one-stage revision TKA with antibiotic cement. Synovial fluid mycobacterial cultures aspirated 2 weeks before the revision surgery became positive on postoperative day 1. PCR identified M kansasii. At 3 weeks postoperatively, intraoperative periprosthetic cultures grew mycobacterium. M kansasii was confirmed using mass spectrometry. Once susceptibilities returned, the patient was treated with targeted antimycobacterial therapy. This case report demonstrates the importance of considering atypical PJI in painful TKA with negative cultures and equivocal laboratory results. In the future, when there is concern for an atypical PJI, molecular diagnostic tools and mycobacterial cultures should be used before surgical intervention.
Author List
Dasari SP, Hadro AE, Singh R, Neilson JCAuthor
John C. Neilson MD Associate Professor in the Orthopaedic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Anti-Bacterial AgentsArthritis, Infectious
Arthroplasty, Replacement, Knee
Humans
Knee Joint
Male
Middle Aged
Mycobacterium kansasii
Prosthesis-Related Infections
