Amphotericin B-loaded bone cement to treat osteomyelitis caused by Candida albicans.

Abstract

in an adult who hadundergone multiple revisions of a hipprosthesis. Treatment was with ampho-tericin B-loaded bone cement. We be-lieve this is the first report of such treat-ment for fungal osteomyelitis.Case report A 59-year-old man (height 180 cm,weight 82 kg) was admitted to the Vancouver Hospital & Health SciencesCentre with a suspected infection after asecond revision total hip arthroplasty.His medical history included an undiag-nosed inflammatory arthropathy forwhich he had undergone a right-sidedtotal hip replacement in 7 years earlier.This had been revised twice because ofaseptic loosening, first 6 years after theoriginal replacement and subsequently 2months before the current admission.The erythrocyte sedimentation rate, C-reactive protein levels and intraoperativesynovial tissue cultures obtained at thetime of these revisions revealed no infec-tion. His course after the second revisionoperation was uncomplicated until 10days before this admission when he hadnight sweats, fever, redness and swellingover the right hip. He did not report anydrug allergies and only reported takingdiclofenac 50 mg orally twice daily, forhis inflammatory arthropathy. On admission, his vital signs includeda blood pressure of 165/90 mm Hg,heart rate of 110 beats/min, and a bodytemperature of 38.1°C. Findings onphysical examination were unremarkableexcept for an area of erythema over themedial portion of the wound on theright hip; the area from the right hipdown to the knee was also edematousand tender. Ultrasonography revealed asmall fluid collection from which 30 mLof turbid serosanguineous fluid was aspirated. This contained 19.7 × 10