candida guilliermondi infection of the knee complicating rheumatoid arthritis: a case report

Abstract

An elderly woman with longstanding rheumatoid arthritis and myasthenia gravis, treated with both systemic and intraarticular corticosteroids, presented with Candida guilliermondi infection superimposed on chronic rheumatoid synovitis of her right knee. This was successfully controlled by surgical debridement (synovectomy) and stabilization of the joint with crossed-pins, leading to a painless fibrous ankylosis. The unusual organism, apparent chronicity of the infection and ultimate success of the surgical treatment are features of this unusual case.

PrimaryCandida guilliermondiiInfection of the Knee in a Patient without Predisposing Factors

“…In our knowledge, primary candidal infection has been reported in less than 15 cases, mostly in neonates [17], septicemic patients, HIV patients, and drug abusers [7–9]. While only some Candida species have been incriminated in the etiology of osteoarticular infections, C. guilliermondii has been reported only one time, by Graham and Frost [15]. Graham reported that a patient with longstanding rheumatoid arthritis and myasthenia gravis presented with mild knee pain and swelling and suggested that the unusualness organism, of the apparent chronicity of the infection, and the ultimate success of the surgical treatment are features of this organism.…”

“…It most often occurs as a result of accidental implantation of fungus during traumatic procedures, such as surgery, intra-articular injections, or implantation of infected joint prostheses [4–6], and also in human-immunodeficiency-virus-(HIV)-infected intravenous drug users [7, 8] and heroin addicts [9]. While some Candida species, including C. albicans, C. krusei, C. parapsilosis, C. tropicalis, C. glabrata, and C. lusitaniae , have been incriminated in the etiology of osteoarticular infections [10–14], C. guilliermondii joint infection has been reported only once, by Graham and Frost [15]. However, the case reported by Graham and Frost occurred in the setting of rheumatoid arthritis, which is one of the minor predisposing factors for candidal infection of joint.…”

CANDIDA SEPTIC ARTHRITIS OF THE HIP IN A YOUNG PATIENT WITHOUT PREDISPOSING FACTORS

“…However, the presence of a positive culture for Candida in the synovial fluid should not be interpreted as a contaminant 1,2,6,8 since this delays diagnosis and treatment. 2 β-D-glucan is a constituent of fungi and elevated plasma levels are common in patients with mycosis or fungaemia. 13 Serological kits with proven clinical application have been developed for the rapid diagnosis of mycoses.…”

“…Septic arthritis caused by Candida species has been described infrequently and there are usually associated predisposing factors. [1][2][3][4][5][6] We describe a previously healthy young patient who developed septic arthritis of the hip caused by Candida albicans and who underwent a two-stage total hip arthroplasty (THA).…”

An approach to monoarthritis

“…Disseminated candidiasis with its accompanying arthritis is seen in patients with serious underlying disorders, IV drug abusers or after prolonged antibiotic therapy. [18] Rare cases have been reported where direct inoculation is caused by repeated injection of a joint or as a contaminant during joint surgery. [19,20] The causative organism in 80% of cases is Candida albicans and remaining cases are caused by Candida tropicalis.…”