Candida arthritis in a patient with chronic myelogenous leukemia (CML) in blastic transformation, unresponsive to fluconazole, but treated effectively with liposomal amphotericin B.
Candida arthritis is quite rare and might be caused either by direct intra-articular inoculation of Candida or secondary to hematogeneous seeding of Candida in immunocompromised hosts. Until now less than 50 cases of Candida arthritis have been reported in the literature. We report a case of Candida arthritis, which occurred in a patient with chronic myelogenous leukemia (CML) in blastic transformation. Aggressive chemotherapy and broad-spectrum antibiotics for a prolonged period for febrile neutropenia had been given to the patient. Arthritis of the left knee appeared during the recovery phase of leukopenia. Despite treatment with fluconazole, no clinical or microbiological improvement was obtained. Thus, administration of liposomal amphotericin B was started and after 3 days there was improvement. We can conclude that fluconazole might not be sufficient in some Candida arthritis cases and liposomal amphotericin B might be a good alternative in these resistant cases.
Turgut
B
B
Department of Hematology, Trakya University Medical School, 22030 Edirne, Turkey. burhanturgut@hotmail.com
Vural
O
O
Demir
M
M
Kaldir
M
M
D000666:Amphotericin B / Q000008:administration & dosage*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000209:etiology; D001752:Blast Crisis; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology; D004338:Drug Combinations; D004351:Drug Resistance; D017809:Fatal Outcome; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy / Q000209:etiology; D010713:Phosphatidylcholines / Q000008:administration & dosage*; D010715:Phosphatidylglycerols / Q000008:administration & dosage*
D004338:Drug Combinations; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B; D015725:Fluconazole