RESUMO
Antecedentes. Las artritis fúngicas de origen hematógeno suelen afectar preferentemente a pacientes con afectación de la inmunidad celular o a usuarios de drogas por vía intravenosa. En el paciente inmunocompetente suele producirse por la inoculación del microorganismo mediante un mecanismo invasor. La experiencia del tratamiento con azoles en estos pacientes es muy escasa. Caso clínico. Presentamos un caso clínico de artritis por Scedosporium apiospermum caracterizado por su lenta instauración, falta de respuesta a posaconazol y caspofungina, y resolución final mediante desbridamiento y tratamiento con voriconazol. Conclusiones. La administración de voriconazol junto al desbridamiento quirúrgico constituye un tratamiento eficaz en la artritis por S. apiospermum(AU)
Background. Fungal arthritis is usually of haematogenous origin, and mainly affects patients with impaired cellular immunity or users of intravenous drugs. The infection in immunocompetent patients is generally caused by direct inoculation of the microorganism through an invasive device. The experience of azole therapy in these patients is limited. Case report. We report a case of arthritis caused by Scedosporium apiospermum characterized by its slow onset, lack of response to posaconazole and caspofungin, and its successful resolution after surgical debridement and treatment with voriconazole. Conclusions. Treatment with voriconazole and surgical debridement is an effective therapy for arthritis due to S. apiospermum(AU)
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Artrite Infecciosa/complicações , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Scedosporium/isolamento & purificação , Scedosporium/patogenicidade , Infiltração-Percolação/métodos , Azóis/uso terapêutico , Articulação do Cotovelo/microbiologia , Articulação do Cotovelo/patologia , Articulação do Cotovelo , Artrite Infecciosa/microbiologia , Artrite Infecciosa/fisiopatologia , Scedosporium , Gálio , Radioisótopos de Gálio , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: Fungal arthritis is usually of haematogenous origin, and mainly affects patients with impaired cellular immunity or users of intravenous drugs. The infection in immunocompetent patients is generally caused by direct inoculation of the microorganism through an invasive device. The experience of azole therapy in these patients is limited. CASE REPORT: We report a case of arthritis caused by Scedosporium apiospermum characterized by its slow onset, lack of response to posaconazole and caspofungin, and its successful resolution after surgical debridement and treatment with voriconazole. CONCLUSIONS: Treatment with voriconazole and surgical debridement is an effective therapy for arthritis due to S. apiospermum.
