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Successful management of Lomentospora prolificans septic arthritis and osteomyelitis in an immunocompetent child: A case report

Summary

A 3-year-old boy developed a serious fungal bone and joint infection caused by Lomentospora prolificans after surgery to fix a broken elbow. This fungus is extremely resistant to most antifungal medications. The infection was successfully treated using multiple approaches: aggressive surgical cleaning, several different antifungal drugs used together, special antibiotic-loaded bone cement, and antiseptic rinses. After two months of intensive treatment, the infection cleared and the child’s arm was saved from amputation.

Background

Lomentospora prolificans is an intrinsically multidrug-resistant filamentous fungus found in environmental reservoirs that causes severe infections in both immunocompromised and immunocompetent hosts. The pathogen was identified as a priority by the WHO in 2022 due to limited effective antifungal treatment options. Pediatric cases of L. prolificans infection are rare, with only 22 cases reported worldwide between 2000 and 2019.

Objective

To report a case of limb-threatening L. prolificans septic arthritis and osteomyelitis in a 3-year-old immunocompetent boy following closed fracture repair and to demonstrate successful management strategies using multimodal therapy.

Results

After multiple operative debridements and multimodal therapy over two months, the patient’s infection was successfully cleared with no positive cultures from day +44 onwards. The patient was discharged on day +102 on dual antifungal therapy and completed treatment on day +184. By day +352, the patient showed improvements in physical activity and functional tasks, though some residual muscle atrophy and restricted elbow movement persisted.

Conclusion

Successful management of L. prolificans osteoarticular infection in an immunocompetent child required aggressive surgical debridement, combination systemic antifungals, novel adjunctive therapies including voriconazole-loaded bone cement and antiseptic irrigation, and multidisciplinary collaboration. Access to novel antifungals like olorofim remains limited for pediatric patients, highlighting the urgent need for enhanced pediatric antifungal research.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40385599, DOI: 10.1016/j.mmcr.2025.100704
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