Pediatric Candida albicans arthritis: case report of hip involvement with a review of the literature.

Candida albicans arthritis in the pediatric patient is rarely reported. In each instance, the patient has had one of the factors that predispose to fungal sepsis: broad spectrum antibiotic therapy, hyperalimentation, prematurity, abdominal surgery, corticosteroid or immunosuppressive therapy, malnutrition, maternal vaginal candidiasis, or lymphoproliferative disorders. To avoid the potentially fatal consequences of delayed treatment, early recognition of the disease is imperative. The patient usually refuses to use the affected joint and plain radiography shows a joint effusion with soft tissue swelling. Osteomyelitis develops in approximately half of the cases. Arthrocentesis with fungal cultures is the best method to make the diagnosis. Treatment is primarily chemotherapeutic and the drug of choice is the membrane inhibitor amphotericin B given intravenously. The antimetabolite 5-fluorocytosine is a second-line drug to be used if resistance develops. All cases before the present one involved the knee joint initially. The case presented involved the left hip and was successfully treated with intravenous amphotericin B.