Tigecycline sclerotherapy for recurrent pseudotumor in aseptic lymphocyte-dominant vasculitis-associated lesion after metal-on-metal total hip arthroplasty: A case report

doi:10.12998/wjcc.v9.i34.10696

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Dec 6, 2021; 9(34): 10696-10701
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10696

Tigecycline sclerotherapy for recurrent pseudotumor in aseptic lymphocyte-dominant vasculitis-associated lesion after metal-on-metal total hip arthroplasty: A case report

I-Hao Lin, Chun-Hao Tsai

I-Hao Lin, Chun-Hao Tsai, Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan

Chun-Hao Tsai, School of Medicine, China Medical University, Taichung 406040, Taiwan

Chun-Hao Tsai, Department of Sports Medicine, China Medical University, Taichung 406040, Taiwan

Author contributions: Tsai CH contributed to the study concept and design; Lin IH and Tsai CH performed data acquisition, Lin IH contributed to manuscript writing; Tsai CH critically revised manuscript, and Lin IH and Tsai CH gave final approval of the manuscript.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Chun-Hao Tsai, MD, PhD, Attending Doctor, Department of Orthopedics, China Medical University Hospital, China Medical University, No. 100 Sec. 1, Jingmao Road, Beitun District, Taichung 406040, Taiwan. ritsai8615@gmail.com

Received: June 2, 2021
Peer-review started: June 2, 2021
First decision: June 25, 2021
Revised: July 6, 2021
Accepted: October 20, 2021
Article in press: October 20, 2021
Published online: December 6, 2021
Processing time: 181 Days and 3.3 Hours

Abstract

BACKGROUND

Metal-on-metal (MoM) total hip arthroplasty (THA) has been associated with adverse reactions to metal debris, presenting clinically as pseudotumors.

CASE SUMMARY

This case report presents a female aged 73 year-old with MoM THA-related pseudotumor. After arthrotomy and bursectomy surgeries, histologic examinations of surgical specimens revealed a specific lymphocyte-dominant immunologic response, now known as aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL). Due to soft tissue persisting effusion after arthrotomy and bursectomy, revision surgery was then performed with ceramic-on-polyethylene THA. However, revision did not resolve the patient’s symptoms. Here we describe our application of tigecycline sclerotherapy to treat recurrent pseudotumor after revision THA and no recurrence after 24-mo follow-up.

CONCLUSION

Tigecycline sclerotherapy is safe and effective in the management of recurrent pseudotumor after revision non-MoM THA in ALVAL cases.

Keywords: Aseptic lymphocyte-dominant vasculitis-associated lesion; Metal-on-metal total hip arthroplasty; Pseudotumor; Tigecycline; Case report

Core Tip: Metal-on-metal (MoM) total hip arthroplasty (THA) often associates with metal debris, presenting as pseudotumors. We here described a case with MoM THA-related pseudotumor. Revision surgery was performed; however, further histologic examinations revealed the presence of aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL) and recurrent pseudotumors formation was noted after revision THA. We locally injected an infusion of tigecycline sclerotherapy for treating the pseudotumor successfully. Our findings indicated that tigecycline sclerotherapy is safe and effective in managing recurrent pseudotumor after revision non-MoM THA in ALVAL cases.