Candida pyarthrosis of the hip and renal homotransplant. Report of a case treated by femoral head and neck resection and 5-fluorocytosine.

A 54-year-old female with chronic renal failure who had undergone renal homotransplantation and who was being maintained for 3 months on immunosuppressive therapy, developed Candida pyarthrosis of the hip. The patient posed a management problem because of the nephrotoxicity of the antibiotics required to control Candida. The literature was of little help in resolving the treatment dilemma because only 4 other cases of Candida pyarthrosis in adults, and only one other on immunosuppressive therapy, have been reported. Surgical excision of the head and neck of the femur was elected because the combined use of Amphotericin B and 5-fluorocytosine posed an unacceptable risk of renal damage while the use of 5-fluorocytosine alone might allow development of step-wise resistance to the drug. Femoral head and neck resection and a 7-month course of 5-fluorocytosine brought the infection under control and allowed normal would healing. With increasing number of compromised susceptible patients, the frequency of serious infections caused by ordinarily saphrophytic organisms is likely to increase. There is a need for more case reports on management, including the consequences of surgical excision of Candida infected tissues.