Chronic septic arthritis and osteomyelitis in a prosthetic knee joint due toClostridium difficile

A case of chronic septic arthritis and osteomyelitis in a prosthetic knee joint due toClostridium difficile is reported. A knee prosthesis was installed in a 16-year-old boy for surgical treatment of an osteosarcoma of the femur. Later, the patient suffered a traumatic closed fracture of his patella, and a sterile fluid was aspirated. One month later, the joint displayed inflammation. Culture of the articular fluid yielded a nontoxigenicClostridium difficile strain. Despite several attempts using conservative medical treatment with penicillins and ornidazole,Clostridium difficile strains with the same antibiotic susceptibility pattern were repeatedly isolated from the joint over an eight-month period. The foreign material was then ablated, and finally, the patient's leg was amputated one year afterClostridium difficile was first isolated. The possible sources of contamination in our case and other reported cases of extraintestinal infection due toClostridium difficile are discussed.