J Bone Jt Infect 2016; 1:50-53. doi:10.7150/jbji.16353

Short Research Communication

Leishmania Infection of a Knee Megaprosthesis

John Papanastasiou2, Andreas F. Mavrogenis1✉, Dimitris Flevas1, Panayiotis D. Megaloikonomos1, Emmanouil Kolimpianakis2, Ioanna Iakovidou3, Panayiotis J. Papagelopoulos1, Nikolaos Demertzis2

1. The First Department of Orthopaedics, Athens University Medical School, ATTIKON University Hospital, Athens, Greece;
2. The Department of Orthopaedics, Ag. Anargyroi Hospital, Athens, Greece;
3. The Department of Pathology, Metaxa Hospital, Athens, Greece.

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Papanastasiou J, Mavrogenis AF, Flevas D, Megaloikonomos PD, Kolimpianakis E, Iakovidou I, Papagelopoulos PJ, Demertzis N. Leishmania Infection of a Knee Megaprosthesis. J Bone Jt Infect 2016; 1:50-53. doi:10.7150/jbji.16353. Available from http://www.jbji.net/v01p0050.htm

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This article presents a 19-year old patient with a distal femoral osteosarcoma treated with limb salvage and distal femoral megaprosthetic reconstruction complicated postoperatively by bone leishmaniasis. Bone biopsy was done; bone tissue was sent for cultures and histology. Cultures were negative. Histological sections showed Leishman - Donovan bodies within histiocytes confirming the diagnosis of leishmania infection of the distal femoral megaprosthesis. The patient was administered amphotericin B for a total of 10 days and gradually became afebrile. Two months after treatment the patient was readmitted with high fever, pancytopenia, liver and spleen enlargement, and chest pain. Radiographs of the chest showed lobar pneumonia and pleural effusion; thoracentesis showed Mycobacterium avium intracellulare lung infection. Despite multi-regimen antibiotic therapy and chemotherapy, disease progressed and the patient died 19 months after osteosarcoma resection and distal femoral megaprosthetic reconstruction from cancer-related complications.

Keywords: Leishmaniasis, Knee megaprosthesis.