Abstract
Fungal arthritis and osteomyelitis are rare and documented mainly in immunocompromised or neutropenic patients. Patients receiving therapeutic immunosuppression for organ transplants have also reported to suffer from aspergillus osteoarthritis. We describe two patients with aspergillus arthritis of the knee joint following fludarabine-based non-myeloablative stem cell transplantation. Both were suffering from acute and chronic GVHD and treated with heavy immunosuppression including steroids and cyclosporine. Interestingly in one of our patients, the arthritis was almost asymptomatic and did not spread to other organs. Heavy pre- and post-transplant immunosuppression is a major risk factor for invasive fungal infection, which can involve remote organs and manifest in an indolent and atypical manner. Bone Marrow Transplantation (2001) 27, 659–661.
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References
Slavin S, Nagler A, Naparstek E et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases Blood 1998 91: 756–763
Wingard JR . Fungal infections after bone marrow transplant Biol Blood Marrow Transplant 1999 5: 55–68
Wagener P, Schulte D, Link H et al. Musculoskeletal manifestations in patients after bone marrow transplantation. Initial clinical rheumatologic observations Z Rheumatol 1991 50: 199–203
Seber A, Khan SP, Kersey JH . Unexplained effusions: association with allogeneic bone marrow transplantation and acute or chronic graft-versus-host disease Bone Marrow Transplant 1996 17: 207–121
Ueda S, Kanamori H, Sasaki S et al. Isolated extramedullary relapse in knee joint after allogeneic bone marrow transplantation for Ph ALL Bone Marrow Transplant 1998 21: 319–321
Varadi G, Or R, Rund D et al. Severe migratory polyarthritis following in vivo CAMPATH-1G Bone Marrow Transplant 1995 16: 843–845
Bordigoni P, Witz F, Von Bueltzingsloewen A et al. Prostaglandin E1 (PGE1) induced arthritis following bone marrow transplantation Br J Haematol 1991 78: 138–139
Socie G, Cahn JY, Carmelo J et al. Avascular necrosis of bone after allogeneic bone marrow transplantation: analysis of risk factors for 4388 patients by the Societe Francaise de Greffe de Moelle (SFGM) Br J Haematol 1997 97: 865–870
Burns LJ, Gingrich RD . Cytomegalovirus infection presenting as polyarticular arthritis following autologous BMT Bone Marrow Transplant 1993 11: 77–79
Anaissie EJ, Kontoyiannis DP, O'Brien S et al. Infections in patients with chronic lymphocytic leukemia treated with fludarabine Ann Intern Med 1998 129: 559–566
Austin KS, Testa NN, Luntz RK et al. Aspergillus infection of total knee arthroplasty presenting as a popliteal cyst. Case report and review of the literature J Arthroplasty 1992 7: 311–314
Toren A, Or R, Ackerstein A, Nagler A . Invasive fungal infections in lymphoma patients receiving immunotherapy following autologous bone marrow transplantation (ABMT) Bone Marrow Transplant 1997 20: 67–69
Cassuto-Viguier E, Mondain JR, Van Elslande L et al. Fatal outcome of Aspergillus fumigatus arthritis in a renal transplant recipient Transplant Proc 1995 27: 2461
Franco M, Van Elslande L, Robino C et al. Aspergillus arthritis of the shoulder in a renal transplant recipient. Failure of itraconazole therapy Rev Rhum 1995 62: 215–218
Taillandier J, Alemanni M, Cerrina J et al. Aspergillus osteomyelitis after heart–lung transplantation J Heart Lung Transplant 1997 16: 436–438
Gunsilius E, Lass-Florl C, Mur E et al. Aspergillus osteoarthritis in acute lymphoblastic leukemia Ann Hematol 1999 78: 529–530
Steinfeld S, Durez P, Hauzeur JP et al. Articular aspergillosis: two case reports and review of the literature Br J Rheumatol 1997 36: 1331–1334
Gardella S, Nomdedeu B, Bombi JA et al. Fatal fungemia with arthritic involvement caused by Trichosporon beigelii in a bone marrow transplant recipient J Infect Dis 1985 151: 566
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Panigrahi, S., Nagler, A., Or, R. et al. Indolent aspergillus arthritis complicating fludarabine-based non-myeloablative stem cell transplantation. Bone Marrow Transplant 27, 659–661 (2001). https://doi.org/10.1038/sj.bmt.1702853
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DOI: https://doi.org/10.1038/sj.bmt.1702853