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This case report describes a 68-year-old woman who developed a large, multilocular pseudotumor secondary to *Granulicatella adiacens* periprosthetic joint infection (PJI) 14 years after primary total hip arthroplasty. The patient underwent pseudotumor resection, neurolysis, staged component exchange, and targeted antibiotic therapy, resulting in successful eradication of the infection and full recovery. This case highlights the diagnostic and therapeutic challenges posed by rare pathogens in PJI.
*Granulicatella adiacens* should be considered in the differential diagnosis of PJI presenting with atypical pseudotumor formation, even with normal inflammatory markers.
Periprosthetic joint infections remain among the most devastating complications after arthroplasty. While typically caused by common pathogens, rare organisms such as Granulicatella adiacens pose unique diagnostic and therapeutic challenges. We describe the first documented case of hip periprosthetic joint infection presenting as giant multilocular pseudotumor in a 68-year-old woman, 14 years after total hip arthroplasty. Despite normal inflammatory markers, aspiration and intraoperative samples identified G adiacens by matrix-assisted laser desorption ionization-time of flight. Multimodal surgical treatment with pseudotumor resection, neurolysis, staged component exchange, and targeted antibiotics led to full recovery and infection-free follow-up. This case highlights the need for heightened awareness of atypical pathogens, underscores the value of advanced diagnostics and interdisciplinary management, and raises the hypothesis that pseudotumor environments may facilitate infection.
