Volume 113, Issue 4, December 2025, 117051Author links open overlay panel, , , , , , , , Highlights•

Successful treatment of A. kalrae arthritis using amphotericin B and voriconazole.

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Summary of published cases of Arthrographis kalrae infections worldwide.

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Overview of antifungal susceptibility patterns in Arthrographis kalrae.

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Recognizing A. Kalrae arthritis: diagnostic challenges and clues.

Abstract

We report the first described case of Arthrographis kalrae knee joint infection in an immunocompetent child previously healthy following a penetrating injury. Arthrographis kalrae is an uncommon etiology in clinical fungal infections. The child was diagnosed with Arthrographis kalrae infection through joint fluid culture in enriched media to the the Saintes Hospital Center and sequencing of the ITS1-ITS4 regions from the colonies obtained at the Poitiers University Hospital. After anterior synovectomy and three revisions for surgical washout, the child was treated by liposomal amphotericin B for 5 days and voriconazole for 6 months. The treatment was well tolerated, although phototoxicity was noted as a side effect of voriconazole. No relapse occurred six months after the cessation of treatment, and the patient was deemed cured. A review of cases in the literature indicates that A. klarae infections can occur in both immunocompetent and immunocompromised patients, often following trauma or the presence of implanted materials. The most commonly affected sites are the eyes (36 %), lungs (18 %) and joints (14 %). Management typically involves a combination of antifungal treatments and surgical interventions in 55 % of case. Prognosis depending on the site and extent of the infection, but is often poor, with complete recovery achieved in only 50 % of reported cases.

Introduction

Arthrographis kalrae is a saprophytic hyaline fungus found in soil and the environment, first described in 1938 from a case of onychomycosis in a 47-year-old man [1]. Infections caused by A. kalrae are rare, with only few cases reported in the literature. Treatment of joint infections typically requires a multidisciplinary approach, combining surgical intervention and extended courses of antifungal therapy.

We report here, to our knowledge, the first case of A. kalrae septic arthritis in an immunocompetent child, and a review of the literature on A. kalrae infections.

Section snippetsCase report

A previously healthy 9-year-old child suffered a penetrating knee injury caused by a metal rod (8 mm thick), with a depth of 8 to 10 cm in April 2024 (day 0). The rod had been used as a post and was contaminated with soil. The radiography initially taken in the emergency department of the Saintes Hospital Center showed pneumarthrosis without visible bone damage. After surgical washing, the child received amoxicillin-clavulanic acid. Cultures from Bacillus cereus was isolated from one of two

Discussion

This case highlights the considerable challenges associated with the diagnosis and treatment of rare Arthrographis kalrae infections. These difficulties are compounded by the scarcity of reported cases, which limits the availability of evidence-based guidance for clinicians managing such unusual fungal infections.

Only 22 cases of Arthrographis kalrae infections have been reported in the literature (Table 1). The most frequently documented manifestations are ophthalmic involvement, particularly

Conclusion

Arthrographis kalrae should be considered an opportunist pathogen of importance and not disregarded when found in operative deep samples. A probabilistic treatment with liposomal amphotericin B at the time of identification, followed by voriconazole, appears to be a good option for this infection. Surgery seems to be necessary to achieve recovery. Face with a paucisymptomatic, abnormal clinical and biological picture in a context where recovery is typically spectacular, rapide and complete,

Ethics statement

The authors declare that the work described has not involved experimentation on humans or animals.

CRediT authorship contribution statement

C. Lemaigre: Writing – original draft. J. Cros-Labrit: Resources. F. Yaouanc: Resources. G. Masse: Resources. T. Pasdeloup: Resources. J. Violette: Resources. M. Meligne: Resources. E. Deffois: Resources. A. Meygret: Writing – review & editing.

Declaration of competing interest

The authors declare that they have no interests.

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