Candida glabrata Olecranon Bursitis Treated With Bursectomy and Intravenous Caspofungin

Abstract

Orthopedic surgeons are becoming more involved in the care of patients with septic arthritis and bursitis caused by yeast species. This case report involves a middle-aged immunocompromised female who developed a Candida glabrata septic olecranon bursitis that developed after she received a corticosteroid injection in the olecranon bursa for presumed aseptic bursitis. Candida (Torulopsis) glabrata is the second most frequently isolated Candida species from the bloodstream in the United States. Increased use of fluconazole and other azole antifungal agents as a prophylactic treatment for recurrent Candida albicans infections in immunocompromised individuals is one reason why there appears to be increased resistance of C. glabrata and other nonalbicans Candida (NAC) species to fluconazole. In this patient, this infection was treated with surgery (bursectomy) and intravenous caspofungin, an echinocandin. This rare infectious etiology coupled with this intravenous antifungal treatment makes this case novel among cases of olecranon bursitis caused by yeasts.

Olecranon Bursitis Caused byCandida parapsilosisin a Patient with Rheumatoid Arthritis

“…Four cases were likely related to corticosteroid injection, including our case [3, 4, 12]. In our patient, although her musculoskeletal deformities and her duties as an administrative assistant predisposed to continuous trauma to the area, her symptoms worsened after the intrabursal injection.…”

“…Five cases, including our case, were secondary to Candida parapsilosis [3, 7, 10, 11]. Two cases were secondary to Candida tropicalis [8, 9], and the other three were due to Candida albicans [1], Candida lusitaniae [13], and Candida glabrata [12] (one each). The subclass identification of Candida species was not done in one patient with subacromial bursitis and the diagnosis was achieved histopathologically after bursectomy was performed [4].…”

“…Six of the 10 reported cases had a chronic course ranging from 4 to 18 months [3, 4, 8, 10, 13]; the remaining cases had an acute onset [1, 7, 9, 12]. In one case, the duration of the disease was not described but it presented 7 months after infliximab therapy was started [11].…”

“…Bursectomy is indicated when there is no response to this treatment, when the bursal fluid cannot be drained with a needle, or when there is infection of the surrounding soft tissue [2]. All of the patients that we describe in Table 1 received antifungal therapy at some point, but 7 required bursectomy to achieve cure [3, 4, 8–12]. Two patients were cured with antifungal therapy alone [1, 7].…”