Propionibacterium Acnes Infection of a Metacarpophalangeal Joint Arthroplasty

Neglected and underestimated in the past, Propionibacterium acnes is currently the most prevalent organism associated with deep prosthetic infections around the shoulder. Surprisingly, it has never been reported as a cause of infection in the hand. Here we report a case of a late presentation of a P. acnes infection in a metacarpophalangeal joint replacement, resulting in chronic low-grade pain with movement. The patient underwent a 2-stage revision, with initial removal of the prosthesis. Positive cultures for P. acnes required 15 days of extended incubation. The patient subsequently had 6 weeks of oral antibiotics followed by a second-stage revision with a Silastic implant.