Candida Parapsilosis Total Hip Arthroplasty Infection: Case Report and Literature Review

A 71 year-old male with a history of diabetes mellitus and right total hip arthroplasty (THA), received a revision surgery on the acetabulum cup of the THA because of loosening. The intraoperative culture yielded Candida parapsilosis. It was regarded as contamination initially. The patient had remained asymptomatic for 4 years after the revision surgery. The radiographs showed no evidence of loosening and the blood inflammatory markers were normal. The only abnormal finding was two subcutaneous swellings over the surgical scar. The patient then presented with right hip pain on walking and low-grade fever. A course of fluconazole had been given for 6 months, but the infection did not improve. Eventually, an excision arthroplasty of the right hip was performed. This case illustrates the rarity and the indolent pattern of presentation of fungal prosthetic infection. High index of suspicion and prompt treatment were needed. Literature on fungal prosthetic infection was also reviewed.