Fungal arthritis with adjacent osteomyelitis caused by Candida pelliculosa : a case report
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CASE REPORT
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Fungal arthritis with adjacent osteomyelitis caused by Candida pelliculosa: a case report Kwang Yun Song1, Chulmin Park2, Ji-Hyun Byun2, Hye-Sun Chun2, Jung-Hyun Choi2,3, Eun Hee Han4, Seung Ok Lee4, Yeonjeong Jeong3,5, Youn Jeong Kim3,5 and Si-Hyun Kim2,3,5*
Abstract Background: Candida sp. osteoarticular infection is rare and most often due to hematogenous seeding during an episode of candidemia in immunocompromised patients. However, the diagnosis can be delayed in patients with subtle symptoms and signs of joint infection without a concurrent episode of candidemia. Case presentation: A 75-year-old woman presented with a three-year history of pain and swelling of the left knee. Candida pelliculosa was detected from the intraoperative tissue when the patient had undergone left total knee arthroplasty 32 months ago, but no antifungal treatment was performed. One year after the total knee arthroplasty, C. pelliculosa was repeatedly isolated from the left knee synovial fluid and antifungal treatment comprising amphotericin B deoxycholate and fluconazole was administered. However, joint infection had extended to the adjacent bone and led to progressive joint destruction. The patient underwent surgery for prosthesis removal and received prolonged antifungal treatment with micafungin and fluconazole. Conclusions: This case shows that C. pelliculosa, an extremely rare non-Candida albicans sp., can cause fungal arthritis and lead to irreversible joint destruction owing to delayed diagnosis and treatment. Keywords: Arthritis, Osteomyelitis, Candida, Micafungin
Background Infectious arthritis may be caused by various pathogens including bacteria, viruses, fungi, and parasites. Although bacterial arthritis is the most common joint infection, Candida, Cryptococcus, and Aspergillus species and other molds are capable of causing fungal arthritis, particularly in immunocompromised or critically ill patients [1, 2]. Fungal arthritis is an uncommon but challenging clinical condition, and Candida spp. are the most common cause. Candida pelliculosa is a rare human pathogen. It is a ubiquitous yeast usually found in fruits, grains, soil, * Correspondence: [email protected] 2 Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea 3 Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Full list of author information is available at the end of the article
plants, and warm-blooded animals. The first case of invasive infection by this pathogen in humans was reported in 1953, and since then there have been a few cases of fungemia, endophthalmitis, and meningitis caused by C. pelliculosa [3–6]. Thus far, cases of osteoarticular infection caused by C. pelliculosa are extremely rare [7]. Herein, we report a case of fungal arthritis with adjacent osteomyelitis caused by C. pelliculosa in an elderly patient with no underlying immunosuppressive condition.
Case presentation A 75-year-old woman pr
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