Artificial hip joint turned out to be caused by an extremely rare

The 77-year-old man’s right artificial hip joint was infected with the bacterium Francisella tularensis, which is responsible for a disease called tularemia, according to the case report, published Oct. 11 in the journal BMJ Case Reports.

Tularemia is also known as “rabbit fever” or “deer fly fever,” because the bacterium can be spread by handling an infected rabbit or being bitten by a deer fly. It can also be spread by tick bites. But in the man’s case, it’s not entirely clear how he picked up the infection.

“We did not find any ticks attached to his skin, although it’s possible he may have had a tick bite or exposure in another form,” said lead author Dr. Harsh Rawal, an internal medicine resident at the University of Illinois College of Medicine at Urbana-Champaign. Rawal was one of the doctors who treated the man.

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The man didn’t remember being bitten by a tick, and he had no pets that may have carried one into his home, according to the report. He also had no contact with any animals that could have transmitted the infection to him.

The man did tell the doctors that he had been a hunter about 50 years ago — some people may get the disease by handling or skinning infected rabbits, muskrats, prairie dogs and other rodents, according to the CDC — but, given his long absence from hunting, this wouldn’t explain how he acquired the infection five decades later.

 

A pain in the hip

After having severe pain in his right hip for about a week, the man went to the emergency room, according to the report. At the time, he said he was concerned because 25 years earlier, he had a total hip replacement done on this hip and an artificial hip joint was inserted.

His doctors decided he needed surgery to repair his artificial hip joint and drain fluid from the area, but they found no evidence of any infection.

But one week after leaving the hospital, the man returned to the emergency room with right hip pain and a fever of 100.6 degrees Fahrenheit.

It was then that the doctors noticed a bulbous skin lesion on one of his shins, according to the report, so they sent the man for blood tests and lab cultures once again.

This time, the tests revealed that the man was infected with F. tularensis.