Indolent aspergillus arthritis complicating fludarabine-based non-myeloablative stem cell transplantation

Fungal arthritis and osteomyelitis are rare and documented mainly in immunocompromised or neutropenic patients. Patients receiving therapeutic immunosuppression for organ transplants have also reported to suffer from aspergillus osteoarthritis. We describe two patients with aspergillus arthritis of the knee joint following fludarabine-based non-myeloablative stem cell transplantation. Both were suffering from acute and chronic GVHD and treated with heavy immunosuppression including steroids and cyclosporine. Interestingly in one of our patients, the arthritis was almost asymptomatic and did not spread to other organs. Heavy pre- and post-transplant immunosuppression is a major risk factor for invasive fungal infection, which can involve remote organs and manifest in an indolent and atypical manner.