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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 healthy child developed a serious fungal bone and joint infection in the elbow after surgery to repair a broken arm bone. The fungus, called Lomentospora prolificans, is extremely resistant to most medications and can lead to limb amputation. Doctors saved the child’s arm by combining multiple approaches: repeated surgeries to clean out infected tissue, three different antifungal medications taken together, special antibiotic-loaded bone cement placed in the elbow, and antiseptic wound washing. After six months of treatment, the infection was cured and the child could use their arm again.

Background

Lomentospora prolificans is an intrinsically multidrug-resistant filamentous fungus found in environmental reservoirs that causes severe infections in both immunocompromised and immunocompetent hosts. It was identified as a priority pathogen by the World Health Organization in 2022 due to its clinical impact and limited treatment options. Reported pediatric infections with L. prolificans 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 highlight the multidisciplinary management approach needed for these difficult-to-treat infections.

Results

The patient developed septic arthritis and osteomyelitis three weeks after K-wire fixation of a supracondylar fracture. L. prolificans was confirmed on culture with high MIC values for all tested antifungals including olorofim. Treatment with combined aggressive surgical debridement, systemic antifungal therapy, voriconazole-loaded PMMA bone cement, and antiseptic irrigation successfully eradicated the infection and preserved limb function, avoiding amputation.

Conclusion

Multidisciplinary collaboration combining aggressive surgical debridement, combination systemic antifungal therapy, and novel adjunctive therapies can successfully manage limb-threatening L. prolificans osteoarticular infections in immunocompetent children. There is an urgent need for enhanced pediatric antifungal research and improved access to novel agents like olorofim for children with drug-resistant fungal infections.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40385599
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