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IsolatedCandida arthritis of both knee joints: Case report and review of the literature

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Journal of Orthopaedic Science

Abstract

Candida infection is an increasing problem in immunocompromised patients. Isolated arthritis without candidemia, which is provoked by direct inoculation ofCandida species intraarticularly, is more uncommon than complicated arthritis following systemic candidiasis. This report describes a 77-year-old man, with various compromising risk factors who developed infectious arthritis in both knees simultaneously, due toCandida glabrata, following intraarticular administration of steroids for 2 years. A favorable outcome was achieved 6 months after radical debridement together with a short period of treatment with amphotericin B. We undertook a literature review of 49 previously reported cases of isolated monarthritis due toCandida species without generalized candidiasis to discuss the pathomechanism, spectrum of pathogen species, clinical characteristics, and treatment. Early diagnosis is the best way to assure a favorable outcome; therefore, we should recognize the possibility of fungal infection when dealing with a patient who has predisposing risk-factors for immunosuppression, particularly repeated intraarticular injection of steroids. In treating aged individuals and those with involvement of both knees, showing an advanced stage with bony destruction, complete debridement, combined with local or systemic administration of antifungal agents, seems preferable to primary arthrodesis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Saitama Medical School, 38 Morohongo, Moroyama, 350-04, Saitama, Japan

    Hiroyuki Shindo, Hiroyuki Morita & Nobuyuki Okuda

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  1. Hiroyuki Shindo
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  2. Hiroyuki Morita
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  3. Nobuyuki Okuda
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Shindo, H., Morita, H. & Okuda, N. IsolatedCandida arthritis of both knee joints: Case report and review of the literature. J Orthop Sci 2, 222–228 (1997). https://doi.org/10.1007/BF02489042

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  • DOI: https://doi.org/10.1007/BF02489042

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