Recurrent arthritis caused by Candida parapsilosis: a case report and literature review

Abstract

Background Candida arthritis is extremely rare and also represents a major challenge of diagnosis and treatment. Here we reported a rare case of recurrent arthritis caused by Candida parapsilosis. Case presentation A 56-year-old Chinese male suffered from recurrent pain and swelling in his right knee after several times of “small needle-knife” acupuncture and corticosteroid injection of the joint. Candida parapsilosis was cultured in his synovial fluid and identified by sequencing of its Internal Transcribed Spacer (ITS) gene. Here we present the radiological characteristics, arthroscopic pictures, and synovium pathology of this patient. Also, blood test and chemical analysis of his synovial fluid were listed as well as the ITS sequence of this Candida species identified. The patient underwent thorough arthroscopic debridement and then set on fluconazole 400 mg daily for 12 months. His symptoms resolved and no relapse was observed on the last follow-up. Additionally, a brief but comprehensive review of C. parapsilosis arthritis episodes from past to now were studied. Conclusion With the detailed clinical information reported in this case and our literature review, we hope they would add to our knowledge of C. parapsilosis arthritis - its clinical settings, laboratory features, radiological characteristics, arthroscopic findings and experience of management. Electronic supplementary material The online version of this article (10.1186/s12879-019-4255-1) contains supplementary material, which is available to authorized users.

Diagnosis and treatment for primary Candida parapsilosis infection of the native knee joint: A case report

“…Healthy hosts can also develop fungal musculoskeletal infections from nosocomial exposures, such as prior surgery or placement of indwelling foreign bodies. Fungal infections can be introduced via direct implantation, as seen in the intravenous drug use community, in trauma victims, and as a complication of parenteral treatment [3] , [6] . The apparent pathogenesis of most cases of Candida arthritis is that of hematogenous dissemination to the joint.…”

“…C . parapsilosis is an opportunistic human pathogenic fungal species and also an uncommon cause of septic arthritis [3] . The most common fungal group causing osteoarticular infection, the Candida, comprises at least 15 distinct species, of which C .…”

“…And, most of the cases were associated with immunosuppressive conditions such as cancer, HIV, chronic steroid use, cancer, and recreational drugs [1] , [2] . It is challenging to diagnose and treat because the clinical manifestations, laboratory and radiologic findings are not specific and not well defined [3] . There are several studies about Candida infection after total knee arthroplasty [3] , but studies of the native knee joint infections are rarely reported.…”

“…It is challenging to diagnose and treat because the clinical manifestations, laboratory and radiologic findings are not specific and not well defined [3] . There are several studies about Candida infection after total knee arthroplasty [3] , but studies of the native knee joint infections are rarely reported. We report on a case that showed good clinical results by performing total knee arthroplasty after treatment with an antifungal agent for C .…”

Diagnosis and unsuccessful management of iatrogenic fungal septic arthritis caused by Wickerhamomyces anomalous (formerly Candida pelliculosa) and concurrent osteochondral lesion

“…The case reported here and that reported by Cohen et al, (2008) and Doyle et al, (2013) both received IA corticosteroid therapy in the days leading up to the development of lameness. The use of IA corticosteroids has been associated with fungal and bacterial arthritis in human patients and this is likely a result of local immunosuppression (Habibet al 2010, Cohen 2011, Bufalari et al 2016, Leclere 2017, Fang et al 2019. Further to the immunosuppression caused by corticosteroids, if combined with antimicrobials this may well increase the risk of fungal infection further.…”