Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
BMC Infect Dis. 2020 Jun 22;20(1):438. doi: 10.1186/s12879-020-05171-8.
Candida sp. osteoarticular infection is rare and most often due to hematogenous seeding during an episode of candidemia in immunocompromised patients. However, the diagnosis can be delayed in patients with subtle symptoms and signs of joint infection without a concurrent episode of candidemia.
A 75-year-old woman presented with a three-year history of pain and swelling of the left knee. Candida pelliculosa was detected from the intraoperative tissue when the patient had undergone left total knee arthroplasty 32 months ago, but no antifungal treatment was performed. One year after the total knee arthroplasty, C. pelliculosa was repeatedly isolated from the left knee synovial fluid and antifungal treatment comprising amphotericin B deoxycholate and fluconazole was administered. However, joint infection had extended to the adjacent bone and led to progressive joint destruction. The patient underwent surgery for prosthesis removal and received prolonged antifungal treatment with micafungin and fluconazole.
This case shows that C. pelliculosa, an extremely rare non-Candida albicans sp., can cause fungal arthritis and lead to irreversible joint destruction owing to delayed diagnosis and treatment.
假丝酵母菌骨关节感染较为罕见，多由免疫功能低下患者发生念珠菌血症时血行播散所致。然而，对于关节感染症状和体征不明显且无念珠菌血症发作的患者，其诊断可能会被延误。
一名 75 岁女性因左膝疼痛和肿胀 3 年就诊。患者在 32 个月前行左全膝关节置换术时，术中组织检测出假丝酵母菌（pelliculosa），但未进行抗真菌治疗。全膝关节置换术后 1 年，左膝关节滑液中反复分离出假丝酵母菌（pelliculosa），给予两性霉素 B 脱氧胆酸盐和氟康唑抗真菌治疗。然而，关节感染已扩展至邻近骨骼，导致进行性关节破坏。患者接受了假体取出手术，并接受了米卡芬净和氟康唑的长期抗真菌治疗。
本例表明，极其罕见的非白假丝酵母菌（pelliculosa）可引起真菌性关节炎，并因诊断和治疗延误而导致不可逆转的关节破坏。
