Bread Mold Osteomyelitis in the Femur

Abstract

Rhizopus osteomyelitis is an uncommon and often fatal infection that usually occurs in immunocompromised patients. The infection is commonly referred to as "bread mold." The usual course of treatment is Amphotericin B, debridement, and, if needed, amputation of the affected limb. This article details a rare case of postoperative Rhizopus osteomyelitis in an otherwise healthy patient. The patient originally presented at another institution for anterior cruciate ligament repair after a ski injury. Postoperatively, he developed clinical evidence of infection. He was referred to our institution with stiffness and swelling in the knee as well as weight loss and decreased range of motion. Fluid collection was visible on magnetic resonance imaging. Arthroscentesis was cultured for fungus and bacteria, and the fungal cultures were positive for Rhizopus species. An attempt at limb salvage was made. Debridement, use of a cement spacer loaded with Amphotericin B, systemic antifungal therapy, and 23 hyperbaric oxygen treatments were used to eradicate the disease. Four surgeries were needed to eradicate the disease, and 10 months after initial presentation, the patient had a distal femoral endoprosthesis placed in his leg. Laboratory tests returned to normal and frozen sections were negative for fungus. At 3-year follow-up, the patient reported a musculoskeletal functional score of 50% and had no evidence of recurrent infection.

Fungal osteomyelitis after arthroscopic anterior cruciate ligament reconstruction: a case report with review of the literature

“…However, we experienced a case of massive distal femoral bone loss induced by fungal infection after ACL reconstruction. As the literature reviewed, only eight cases of fungal osteomyelitis with terrible bone destruction after ACL reconstruction were reported by three groups of authors [7][8][9]. Unlike the eight patients who suffered from Rhizopus, Candida albican or Phycomycoses infection, the patient reported by us was infected with Aspergillus.…”

“…Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts and one with an intercalary allograft arthrodesis. Wilkins et al [9]. described that a 51-year-old man with ACL repair developed clinical evidence of infection.…”

Biofilm formation by zygomycetes: quantification, structure and matrix composition

“…In addition, these fungi have been implicated in central-venous-catheter-associated fungaemia (Chan-Tack et al, 2005), peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (Branton et al, 1990;Fergie et al, 1992;Nakamura et al, 1989;Nannini et al, 2003;Nayak et al, 2007;Polo et al, 1989;Serna et al, 2003), pleuritis following implantation of drainage catheters (Kimura et al, 2009), endocarditis on native (Mehta et al, 2004;Mitchell et al, 2010) and artificial heart valves (Gubarev et al, 2007;Sanchez-Recalde et al, 1999), osteomyelitis (Chaudhuri et al, 1992;Eaton et al, 1994;Lopes et al, 1995;Meis et al, 1994;Wilkins et al, 2009), and paranasal fungal balls (Goodnight et al, 1993;Kirkpatrick et al, 1979;Lahiri et al, 2001;Robey et al, 2009). Many of these infections are associated with biofilm formation (Costerton et al, 1999;Hall-Stoodley et al, 2004;Loussert et al, 2010) and were reported to exhibit a chronic course (Eaton et al, 1994;Lahiri et al, 2001;Lopes et al, 1995).…”

Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment

“…Wilkins reported the case of a non-immunocompromised patient with a postoperative RM osteomyelitis of the femur after anterior cruciate ligament repair. Multimodal treatment led to eradication of the disease [12]. A successful treatment of RM osteomyelitis of the right tibia in an immunocompromised patient was presented by Vashi [9].…”