Mycotic arthritis of the knee caused by Arthrographis kalrae in an immunocompetent child: A case report and litterature review

We report the first described case of Arthrographis kalrae knee joint infection in an immunocompetent child previously healthy following a penetrating injury. Arthrographis kalrae is an uncommon etiology in clinical fungal infections. The child was diagnosed with Arthrographis kalrae infection through joint fluid culture in enriched media to the the Saintes Hospital Center and sequencing of the ITS1-ITS4 regions from the colonies obtained at the Poitiers University Hospital. After anterior synovectomy and three revisions for surgical washout, the child was treated by liposomal amphotericin B for 5 days and voriconazole for 6 months. The treatment was well tolerated, although phototoxicity was noted as a side effect of voriconazole. No relapse occurred six months after the cessation of treatment, and the patient was deemed cured. A review of cases in the literature indicates that A. klarae infections can occur in both immunocompetent and immunocompromised patients, often following trauma or the presence of implanted materials. The most commonly affected sites are the eyes (36 %), lungs (18 %) and joints (14 %). Management typically involves a combination of antifungal treatments and surgical interventions in 55 % of case. Prognosis depending on the site and extent of the infection, but is often poor, with complete recovery achieved in only 50 % of reported cases.