title: Candida albicans osteomyelitis of the zygomatic bone. A distinctive case with a possible peculiar mechanism of infection and therapeutic failure with fluconazole.
abstract: This report describes a distinctive case of zygomatic candidiasic osteomyelitis in a diabetic patient with oral candidiasis and malar ulceration secondary to topic 5-fluoroacil toxicity that eventually exposed part of the underlying bone. The mechanism of infection may have been self-inoculation of spores from muguet plaques on the oral mucosa to the exposed bone tissue by hand contact. Such a mechanism of bone infection probably should be considered in patients who frequently have oral candidiasis (diabetes, malignancies, and HIV infection) and open lesions of the skin and soft tissues. Treatment with fluconazole was ineffective, but amphotericin B was curative.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Madrid, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Arranz-Caso
authors.forename: V M
authors.initials: VM
authors.lastname: Lopez-Pizarro
authors.forename: P
authors.initials: P
authors.lastname: Gomez-Herruz
authors.forename: J
authors.initials: J
authors.lastname: García-Altozano
authors.forename: J
authors.initials: J
authors.lastname: Martinez-Martinez
mesh_terms: D000280:Administration, Inhalation; D000666:Amphotericin B / Q000627:therapeutic use; D001706:Biopsy; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology; D002180:Candidiasis, Oral / Q000150:complications / Q000188:drug therapy; D048909:Diabetes Complications; D015725:Fluconazole / Q000627:therapeutic use*; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology*; D013256:Steroids / Q000009:adverse effects; D015050:Zygoma / Q000382:microbiology
chemical_list: D013256:Steroids; D000666:Amphotericin B; D015725:Fluconazole; D005472:Fluorouracil