Candida albicans arthritis in a nonimmunocompromised patient. Complication of placebo intraarticular injections.
A nonimmunocompromised 32-year-old man with arthrosis of the knee participated as a placebo control in a clinical trial of intraarticular injections of hyaluronan. After the fourth weekly injection of saline, he developed a warm and swollen knee, and synovial fluid cultures revealed growth of Candida albicans. Oral fluconazole treatment was instituted 2 weeks after onset of symptoms, but failed to eradicate the infection. The patient recovered after treatment with local and systemic amphotericin B, systemic 5-fluorocytosine and surgical synovectomy. Quantitation of joint cartilage proteoglycan fragments in synovial fluid indicated extensive breakdown of cartilage during the acute phase of arthritis but, parallel to clinical recovery, these levels returned to normal.
Christensson
B
B
Department of Infectious Diseases, University Hospital, Lund, Sweden.
Ryd
L
L
Dahlberg
L
L
Lohmander
S
S
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000382:microbiology*; D002176:Candida albicans; D002177:Candidiasis / Q000188:drug therapy / Q000635:transmission*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005437:Flucytosine / Q000008:administration & dosage; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007270:Injections, Intra-Articular / Q000009:adverse effects*; D008297:Male; D000074402:Synovectomy
D000666:Amphotericin B; D006820:Hyaluronic Acid; D005437:Flucytosine