Echinocandins are approved for the treatment of candidal infections. In vitro they have been shown to be less potent against strains of Candida parapsilosis than against other Candida spp. This is the first case report describing the development of a secondary multidrug (echinocandin-azole)-resistant Candida strain during therapy.

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Clostridium paraputrificum is an extremely rare species and constitutes only 1% of all clostridium infections in literature. Septic arthritis from Clostridium paraputrificum is even less documented, and currently there is only one known case report. Specifically, patients with sickle cell disease have a well-documented and increased susceptibility to infections with Salmonella, Streptococcus pneumoniae, Hemophilius influenzae , and Enterobacter-klebsiella . Clostridium infection in sickle cell patients has been less studied and described. Here we present a case of septic arthritis from Clostridium paraputrificum in a sickle cell disease patient likely provoked by underlying avascular necrosis of the right shoulder.