Candida glabrata arthritis: case report and review of the literature of Candida arthritis

• Published in: Clinical rheumatology 1999-01, Vol.18 (5), p.406-409
• Main Authors: Zmierczak, H, Goemaere, S, Mielants, H, Verbruggen, G, Veys, E M
• Format: Article
• Language: English
• Subjects: Adult; Amphotericin B - therapeutic use; Ankle Joint - diagnostic imaging; Ankle Joint - microbiology; Arthritis; Arthritis, Infectious - diagnostic imaging; Arthritis, Infectious - microbiology; Candida - isolation & purification; Candidiasis - complications; Candidiasis - diagnosis; Candidiasis - drug therapy; Humans; Injections, Intra-Articular; Male; Medical treatment; Radiography; Synovial Fluid - microbiology
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s100670050127

We report a case of arthritis due to Candida (Torulopsis) glabrata in two different joints at different times in the same patient. The first episode of arthritis was situated in the right ankle and lasted more than 1 year before the patient agreed to the proposed treatment. Therapy with intravenous amphotericin B and oral fluconazole failed. A cure was achieved with weekly intra-articular administration of amphotericin B, which was continued for more than 20 weeks and combined with oral itraconazole. Several weeks later the patient developed Candida glabrata arthritis of the left knee while still taking itraconazole. Immediately, intravenous amphotericin B therapy was started and was successful. Because there were no previous invasive point manipulations or trauma, the infections were considered to be haematogenously disseminated. Chronic corticosteroid and repeated antibiotic therapy for infectious exacerbations of chronic obstructive pulmonary disease and alcohol abuse are the presumed risk factors in this otherwise immunocompetent patient.