Scedosporium prolificans Septic Arthritis

Scedosporium prolificans is an emerging fungal pathogen that can cause significant morbidity, and even mortality, in both immunocompromised and immunocompetent patients. Approximately 10% of patients affected by this rare fungal pathogen present with septic osteomyelitis or arthritis. Overall, the rate of mortality is close to 50%, and several patients with orthopedic infections have required amputations.1 Our patient is a 59-year-old woman, with a history of rheumatoid arthritis requiring immunosuppressants, who presented with a 5-month history of right wrist pain and swelling. She described an oscillating course of swelling, erythema, and pain involving the dorsal aspect of her wrist that did not show sustained response to antibiotics or a radiocarpal joint steroid injection given by other providers. On initial examination, she was afebrile with dorsal wrist swelling. There was no erythema, but wrist mobility was limited. She had tenderness throughout the wrist, but no fluctuance or drainage. All initial laboratory work was normal. Right wrist X-ray showed severe osteopenia with some mild evidence of cortical erosion. Despite the normal laboratory values, her presenting findings of swelling, radiographic erosions, and immunocompromised state prompted concern for atypical septic arthritis. The patient subsequently underwent wrist exploration for tissue and culture harvest. In addition to extensive wrist synovectomy, the proximal pole of the scaphoid, lunate, triquetrum, capitate, hamate, and metacarpal bases all showed evidence of necrosis that required debridement. One week later, her fluid aspirate and bone cultures unexpectedly grew an unidentified fungal species, and she was taken back to the operating room for further debridement and placement of a voriconazole-impregnated cement spacer. The culture grew pan-resistant Scedosporium prolificans, and based on recommendations from Rheumatology and Infectious Disease, the patient was started on a 6-week course of intravenous micafungin, and immunosuppressive medications were stopped. She returned to the operating room for debridement and serial treatments with polyhexamethylene biguanide (PHMB) irrigation until intraoperative tissue cultures showed no growth. PHMB is an antiseptic medication that has been described as a local adjunct to the treatment of resistant fungal infections.2–4 After successful eradication of her infection, she underwent wrist reconstruction and fusion with a double-barrel free fibula osteocutaneous flap. She is now 18 months out from her reconstruction, has healed uneventfully, and has a functional, painless upper extremity

Junior Recital: Brian Reid, jazz piano

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Performance. Mr. Reid studies jazz piano with Tyrone Jackson.https://digitalcommons.kennesaw.edu/musicprograms/1121/thumbnail.jp

Senior Recital: Brian Reid, jazz piano

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Performance. Mr. Reid studies jazz piano with Tyrone Jackson.https://digitalcommons.kennesaw.edu/musicprograms/1804/thumbnail.jp

Senior Recital: Brandon Radaker, saxophone

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Performance. Mr. Radaker studies saxophone with Sam Skelton.https://digitalcommons.kennesaw.edu/musicprograms/1949/thumbnail.jp

Junior Recital: Nicolas Chambers, saxophone

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Performance. Mr. Chambers studies saxophone with Sam Skelton.https://digitalcommons.kennesaw.edu/musicprograms/1109/thumbnail.jp

Undergraduate Research Journal, Volume 14

Table of Contents: The Myth of Chechen Radical Islam / by Jonathan Parker (p.1-8) -- Genre and the Perception of Massacre... / by Lauren Ferguson (p.9-18) -- Sentinel of Liberty: Captain America on the Home Front in WWII / by Carolyn McNamara (p.19-34) -- Embracing Myth in Mrs. Dalloway / by Aza Pace (p.35-48) -- Cannibalism and Witchcraft in The Tempest / by Kenneth F. Harlock (p.49-62) -- Evolutionary Game Models of Optimal Nuclear Weapons Strategies / by Christina Kent (p.63-82) -- Optimization for a Bio-Impedance Measurement System / by Matthew Normayle (p.83-94)Senate of College Council

Junior Recital: Jonathan Pace, jazz percussion

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Performance. Mr. Pace studies jazz percussion with Justin Chesarek.https://digitalcommons.kennesaw.edu/musicprograms/1802/thumbnail.jp