Abstract
INTRODUCTION: Fungal musculoskeletal infections are rare and often present diagnostic and therapeutic challenges, particularly in immunocompromised individuals. Phaeohyphomycosis is a dematiaceous fungal infection with a wide clinical spectrum, but isolated prepatellar bursitis due to this organism has not been previously reported. This case highlights the importance of maintaining a high index of suspicion for unusual pathogens in transplant recipients presenting with atypical joint or periarticular infections. CASE REPORT: We report the case of a 55-year-old female renal transplant recipient on long-term immunosuppressive therapy who presented with progressive swelling and pain over the anterior aspect of the knee. Clinical examination revealed localized swelling consistent with prepatellar bursitis, with no systemic features of infection. Initial aspiration yielded dark-colored fluid, and microscopy demonstrated pigmented fungal elements. Fungal culture confirmed the diagnosis of phaeohyphomycosis. The patient underwent surgical bursectomy followed by antifungal therapy, with gradual resolution of symptoms. At the latest follow-up, she remained asymptomatic with no evidence of recurrence. CONCLUSION: This case underlines the need for early recognition of unusual infectious agents in immunosuppressed patients with persistent musculoskeletal complaints. Isolated fungal bursitis due to phaeohyphomycosis is extremely uncommon, and timely surgical intervention combined with appropriate antifungal therapy is critical for favorable outcomes. Orthopedic surgeons should be aware of this rare entity, as prompt diagnosis and multidisciplinary management can prevent morbidity and preserve function.