SHM Converge Scientific Abstract ePoster Gallery-28 Days Later

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This poster describes a rare case of <strong>Histoplasma capsulatum prosthetic joint infection (PJI)</strong> presenting as persistent fungemia and rapid clinical decline in an immunosuppressed patient.

A <strong>55-year-old woman</strong> with <strong>rheumatoid arthritis</strong> and <strong>bilateral knee replacements</strong> presented with <strong>7 days of weakness, nausea, diarrhea, and left knee pain</strong>. Her medications included <strong>methotrexate, infliximab, leflunomide, and prednisone</strong>, placing her at high risk for disseminated fungal infection. On exam, she was <strong>hypotensive, tachycardic, tachypneic, diaphoretic, and pale</strong>, with a <strong>warm, slightly effused left knee</strong>. Workup showed <strong>thrombocytopenia</strong>, <strong>yeasts seen in red blood cells on blood smear</strong>, and elevated inflammatory markers. Chest imaging was unremarkable. A <strong>knee aspirate</strong> was obtained and cultured.

Despite empiric antimicrobial treatment, fluid resuscitation, and vasopressor support, the patient deteriorated and died from <strong>disseminated histoplasmosis</strong>. The key diagnostic finding came <strong>28 days later</strong>, when the knee aspirate culture grew <strong>Histoplasma capsulatum</strong>.

The authors emphasize that <strong>H. capsulatum PJI is extremely rare</strong>, with only <strong>7 reported cases</strong> in their literature review. Most reported cases involved the <strong>knee prosthesis</strong>, suggesting it may be a particularly susceptible site. Diagnosis is often delayed because <strong>blood cultures, serology, and urine Histoplasma tests are frequently negative</strong>, and the organism may only be identified through <strong>synovial fluid or tissue culture</strong> after prolonged incubation.

The poster highlights the importance of considering <strong>prosthetic joint infection as a source of persistent histoplasmosis</strong>, especially in <strong>immunosuppressed patients with joint symptoms</strong>.

Asset Subtitle

Conor Houlihan

Meta Tag

Author List Conor Houlihan, Michael P. Smith

Category Clinical Vignettes

Concept Histoplasma Organism

Concept Prosthetic Joint Infection

Concept Immunosuppression

Concept Synovial fluid culture

Concept Immunosuppressed Patients

Distinguished Non-Finalist

Presenter Organization University of Nebraska Medical Center

Presenting Author Conor Houlihan

Track Adult

Keywords

Histoplasma capsulatum

prosthetic joint infection

disseminated histoplasmosis

immunosuppressed patient

rheumatoid arthritis

knee prosthesis

fungemia

synovial fluid culture

persistent histoplasmosis

prednisone infliximab methotrexate

Histoplasma Organism

Prosthetic Joint Infection

Immunosuppression

Synovial fluid culture

Immunosuppressed Patients