Rare Pseudotumor in Ceramic-On-Ceramic Total Hip Replacement with Concomitant Fungal Periprosthetic Joint Infection: A Case Report

Patient: Female, 67-year-old Final Diagnosis: Infection Symptoms: Swelling • unprovoked DVT Clinical Procedure: — Specialty: Orthopedics and Traumatology OBJECTIVE: Rare disease BACKGROUND: Total hip replacement (THR) is a commonly performed treatment for severe osteoarthritis. In this report, we present the case of a woman who unfortunately suffered 2 severe but rare complications of THRs: a pseudo-tumor formation on a Delta ceramic-on-ceramic bearing and a fungal periprosthetic joint infection (PJI). CASE REPORT: In early 2016, a 63-year-old woman underwent an elective left total hip replacement with ceramic-on-ceramic bearing due to severe osteoarthritis. In 2021, she suffered 2 unprovoked DVTs. Therefore, ultrasound (US) Doppler imaging of the left lower limb was performed, which showed a mass close to the iliac vein. After magnetic resonance imaging (MRI) to further examine the mass, a pseudotumor was confirmed. Revision surgery was performed, after which positive swabs for fungal infection were identified, but were not clinically correlated. A few years before, a deep buccal fungal infection was suspected and treated, but never confirmed. The pseudotumor was confirmed by histology samples. A few weeks later, the patient presented again with symptoms of infection, and 2 debridement, antibiotics, and implant retention (DAIR) procedures were performed, in which further positive swabs of Candida parapsilosis were obtained. Currently, the patient is on conservative therapy with long-term antifungal medication since she refused a staged procedure due to personal circumstances. CONCLUSIONS: In conclusion, this case report documents the first ever reported pseudotumor associated with a ceramic-on-ceramic bearing THR with concomitant fungal PJI. Although it is unlikely for a person to develop 2 rare complications without them being connected, no causal link could be established.