Septic arthritis as the first sign of Candida tropicalis fungaemia in an acute lymphoid leukemia patient

Abstract

Fungal infections caused by Candida species have increased in incidence during the past two decades in England, North America and Europe. Candidal arthritis is rare in patients who are not intravenous drug users or are who not using a prostheses. We report the case of a 24-year-old man with acute lymphoid leukemia, who developed Candida tropicalis arthritis during an aplastic period after chemotherapy. This is the eighth case described in the literature of C. tropicalis causing arthritis without intra-articular inoculation. We call attention to an unusual first sign of fungal infection: septic arthritis without intra-articular inoculation. However, this case differs from the other seven, since despite therapy a fast and lethal evolution was observed. We reviewed reported cases, incidence, risk factors, mortality and treatment of neutropenic patients with fungal infections.

Septic Arthritis Versus Transient Synovitis of the Hip: Gadolinium-Enhanced MRI Finding of Decreased Perfusion at the Femoral Epiphysis

“…In our study, one adult with septic arthritis of the hip had decreased perfusion of the femoral epiphysis on MRI, and Candida tropicalis grew on culture of aspirate. C. tropicalis arthritis has been found in patients with hematologic malignant disease, and septic arthritis can be the first sign of C. tropicalis infection [31][32][33][34]. Our patient later proved to have hemophagocytic lymphohistiocytosis.…”

Candida albicans induces cyclo-oxygenase 2 expression and prostaglandin E2 production in synovial fibroblasts through an extracellular-regulated kinase 1/2 dependent pathway

“…Articular structures can be affected by mycotic infections through direct inoculation, contiguous spread, or hematogenous dissemination [ 1 - 4 ]. Of the various Candida species, Candida albicans is most commonly associated with fungal arthritis, especially in immunocompromized individuals [ 4 - 7 ]. Typically infection predominates in large weight-bearing joints, most often the knee [ 8 ].…”

Candida krusei arthritis in a boy with acute lymphoblastic leukemia

“…Despite its toxicity, AmB was the initial drug used in 68% cases of Candida arthritis [5,8,13] and its good penetration into the synovial fluid has been shown when given intravenously [15]. Farrell et al [15] concluded that adequate synovial fluid concentration of AmB was achieved during systemic therapy and intra-articular administration was ordinarily unnecessary.…”

“…Fungal arthritis is a relatively rare complication that occurs in neutropenic patients with hematological disease and cancer especially those receiving prophylactic FCZ and broad-spectrum antibiotics. C. albicans has been reported to be the most common species causing fungal arthritis [3] followed by Candida tropicalis (C. tropicalis) [4][5][6][7][8][9], while C. krusei still remains very rare [9][10][11].…”