{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T22:39:01Z","timestamp":1776119941482,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,10,24]],"date-time":"2021-10-24T00:00:00Z","timestamp":1635033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Postoperative infections after arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) represent a rare but severe complication. An extremely rare case of Aspergillus septic arthritis in a 27-year-old patient following arthroscopic ACLR is reported. The patient presented with signs of knee infection 14 days after ACLR. Two consecutive arthroscopic debridements were performed, while eventually histopathology, cultures and multiplex PCR test revealed Aspergillus identified as A. fumigatus by mass spectrometry. The patient commenced long-term treatment with voriconazole. Fungal arthritis or osteomyelitis following ACLR has a mild local and general inflammatory reaction when compared to the bacterial ones. Nevertheless, such infections may lead to aggressive osseous destruction and necrosis. A high index of suspicion is of utmost importance for early detection, while microscopic, histological examination and multiplex PCR may be more helpful for the diagnosis than cultures since cultures are more time-consuming and may vary depending on different factors.<\/jats:p>","DOI":"10.3390\/diagnostics11111975","type":"journal-article","created":{"date-parts":[[2021,10,24]],"date-time":"2021-10-24T22:06:16Z","timestamp":1635113176000},"page":"1975","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Fungal Septic Knee Arthritis Caused by Aspergillus fumigatus following Anterior Cruciate Ligament Reconstruction"],"prefix":"10.3390","volume":"11","author":[{"given":"George","family":"Samonis","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University Hospital of Heraklion, Crete, 71500 Heraklion, Greece"},{"name":"\u201cMetropolitan\u201d General Hospital, N. Faliron, 18547 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Koutserimpas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, \u201c251\u201d Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4766-8238","authenticated-orcid":false,"given":"Georgia","family":"Vrioni","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elsa","family":"Kampos Martinez","sequence":"additional","affiliation":[{"name":"\u201cMetropolitan\u201d General Hospital, N. Faliron, 18547 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiotis","family":"Kouloumentas","sequence":"additional","affiliation":[{"name":"\u201cMetropolitan\u201d General Hospital, N. Faliron, 18547 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0185-8474","authenticated-orcid":false,"given":"Kalliopi","family":"Alpantaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, \u201cVenizeleion\u201d General Hospital of Heraklion, Crete, 71409 Heraklion, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Saroglou","sequence":"additional","affiliation":[{"name":"\u201cMetropolitan\u201d General Hospital, N. Faliron, 18547 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1177\/0363546519867913","article-title":"Complications After Anterior Cruciate Ligament Reconstruction and Their Relation to the Type of Graft: A Prospective Study of 958 Cases","volume":"47","author":"Rousseau","year":"2019","journal-title":"Am. J. Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.mycmed.2018.09.002","article-title":"Mucormycosis outbreak due to Rhizopus microsporus after arthroscopic anterior cruciate ligament reconstruction surgery evaluated by RAPD and MALDI-TOF Mass spectrometry","volume":"28","author":"Gamarra","year":"2018","journal-title":"J. Mycol. M\u00e9d."},{"key":"ref_3","first-page":"00147","article-title":"Candida Glabrata Septic Arthritis Involving the Right Knee After Anterior Cruciate Ligament Graft Placement","volume":"4","author":"Castro","year":"2016","journal-title":"MOJ Orthop. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Waterman, B.R., Arroyo, W., Cotter, E.J., Zacchilli, M.A., Garcia, E.J., and Owens, B.D. (2018). Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal. Orthop. J. Sports Med., 6.","DOI":"10.1177\/2325967118758626"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2106\/00004623-200203000-00019","article-title":"Fungal infection following replacement of the anterior cruciate ligament: A case report","volume":"84","author":"Burke","year":"2002","journal-title":"J. Bone Jt. Surg. 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Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.knee.2011.10.007","article-title":"Fungal osteomyelitis after arthroscopic anterior cruciate ligament reconstruction: A case report with review of the literature","volume":"19","author":"Sun","year":"2012","journal-title":"Knee"},{"key":"ref_9","first-page":"310","article-title":"Outbreak of serial knee joint sepsis after arthroscopic surgery: A case series with the guideline for treatment","volume":"52","author":"Mirzatolooei","year":"2014","journal-title":"Acta Medica Iran."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1007\/s00167-013-2648-z","article-title":"Recommendations for the management of septic arthritis after ACL reconstruction","volume":"22","author":"Wang","year":"2013","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1111\/myc.12736","article-title":"Candida glabrata prosthetic joint infection, successfully treated with anidulafungin: A case report and review of the literature","volume":"61","author":"Koutserimpas","year":"2017","journal-title":"Mycoses"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1080\/14787210.2020.1748499","article-title":"Management of osteoarticular fungal infections in the setting of immunodeficiency","volume":"18","author":"Papachristou","year":"2020","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.12998\/wjcc.v7.i12.1430","article-title":"Non-albicans Candida prosthetic joint infections: A systematic review of treatment","volume":"7","author":"Koutserimpas","year":"2019","journal-title":"World J. Clin. 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Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.3390\/diagnostics11081410","article-title":"Non-Candida Fungal Prosthetic Joint Infections","volume":"11","author":"Koutserimpas","year":"2021","journal-title":"Diagnostics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1128\/AAC.05394-11","article-title":"Antifungal Susceptibilities of Aspergillus fumigatus Clinical Isolates Obtained in Nagasaki, Japan","volume":"56","author":"Tashiro","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.idc.2015.10.012","article-title":"Antifungal Agents: Spectrum of Activity, Pharmacology, and Clinical Indications","volume":"30","author":"Nett","year":"2016","journal-title":"Infect. Dis. Clin. N. 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Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s11046-014-9757-1","article-title":"MALDI-TOF Mass Spectrometry: Any Use for Aspergilli?","volume":"178","author":"Sanguinetti","year":"2014","journal-title":"Mycopathologia"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/11\/1975\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:22:13Z","timestamp":1760167333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/11\/1975"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,24]]},"references-count":22,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["diagnostics11111975"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11111975","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,24]]}}}