Cryptococcus neoformans Periprosthetic Joint Infection in the Setting of Revision Shoulder Arthroplasty: A Case Report

An 83-year-old male, status one year post-primary right reverse shoulder arthroplasty, presented with clinical and radiographic signs of shoulder instability. The patient subsequently underwent revision reverse shoulder arthroplasty with postoperative cultures growing Cryptococcus neoformans in all five tissue samples. He was placed on temporary fluconazole since he demanded to leave the hospital during a holiday weekend with plans to get readmitted later. IV amphotericin B was used as induction treatment for two weeks followed by PO voriconazole, which was taken by the patient until eight months postoperatively. He was followed up in the orthopedic clinic status post revision procedure at one and two months and was found to be progressing well. The patient presented to the emergency department eight months after the revision procedure for an unrelated concern that was inconsequential. There were no signs of infection as vital signs and laboratory markers were normal. At 18 months postoperatively, he presented to an outside facility with a left distal femur periprosthetic fracture around a total knee implant, for which open reduction and internal fixation (ORIF) was performed. During this hospital stay, an orthopedic team, known to the authors, evaluated the patient. The right shoulder was stable and without pain, with vitals signs and laboratory markers showing no signs of infection. The patient reported that he continued to be employed as a maintenance worker at a motel. He was discharged soon and is living with current revision shoulder arthroplasty implants.