Erysipelothrix rhusiopathiae Prosthetic Joint Infection in an Immunocompromised Patient

Abstract

Case: We report the case of an immunosuppressed 65-year-old man with prosthetic joint infection (PJI) 23 years postoperatively because of Erysipelothrix rhusiopathiae, through hematogenous seeding of cutaneous erysipeloid. Immunotherapy was discontinued, washout was performed, and antimicrobial therapy was guided by laboratory sensitivities. The patient was discharged on suppressive oral ciprofloxacin monotherapy. First-stage revision was performed at 5 months after presentation—subsequent aspiration at 1 year postoperatively demonstrated no organisms and no leucocytes. At 18-month follow-up, the patient continues to do well and has elected not to proceed with second-stage surgery. Conclusion: E. rhusiopathiae is a rarely seen pathogen in PJI—it should be considered with immunosuppression and relevant exposure risks. The patient achieved good clinical outcome and has experienced no sequelae to date.

Disseminated Erysipelothrix rhusiopathiae with Secondary Prosthetic Hip Joint Infection

“…All reported cases had complete symptomatic and biochemical resolution of their infection. 7,8,[14][15][16][17][18] This case highlights the importance of considering disseminated zoonotic infections in the setting of prosthetic joint infection in at-risk populations. It also highlights the difficulty in diagnosing some of these zoonotic infections.…”

“…Identification of the organism, determining antibiotic sensitivity of that organism, and surgical intervention continues to be the mainstay of management. 17 Although eventually identified correctly, the organism in this case was initially misidentified as a gram-negative rod. This is not uncommon because previously documented cases have also reported E. rhusiopathiae to have Gram-variable staining 2 .…”

“…Identification of the organism, determining antibiotic sensitivity of that organism, and surgical intervention continues to be the mainstay of management. 17…”

“…In the 7 reported cases of prosthetic joint infection secondary to E. rhusiopathiae, 5 involved knee prostheses and the other 2 were hip prostheses 7,8,[14][15][16][17][18] . There were no reported precipitants such as abrasion injuries.…”

A recurrent prosthetic joint infection caused by Erysipelothrix rhusiopathiae: case report and literature review

“…Identification of E. rhusiopathiae in the microbiology laboratory is largely facilitated by MALDI-TOF MS technology. Infection with E. rhusiopathiae has probably been underestimated so far and its identification may now be easier to achieve [19]. 16S rRNA gene sequencing has shown its usefulness in many clinical cases, particularly in cases of blood culture-negative endocarditis [20,21].…”