Candida tropicalis Arthritis of the Knee in a Patient with Acute Monocytic Leukemia.

The patients with malignant hematopathy are the high-risk group of invasive fungal infections (IFI). Candidemia and IFI caused by Candidas in patients with a hematological malignancy are common but Candida arthritis is rare. Here, we reported a case of Candida tropicalis arthritis of the knee that occurred with acute monocytic leukemia during the recovery period of post chemotherapy myelosuppression and agranulocytosis.

Case report: A 45-year-old Chinese woman was diagnosed with acute monocytic leukemia with normal caryotype in november 2004. Complete remission was achieved upon completion of 2 courses of induction chemotherapy. Treatment was administered via a Hickman catheter in the left elbow. Two days after phase V consolidation chemotherapy, the patient experienced high fever accompanied by the development of arthritis in the right knee. The diagnosis of Candida tropicalis arthritis of the knee was confirmed by the appearance of Candida tropicalis isolated from the synovial fluid, but no leukemic cells and acid-fast bacilli were found. According to the susceptibility test in vitro, itraconazole and amphotericin B injection were used sequentially for therapy for 4–5 weeks, which effectively inhibited bacterial growth. However, the arthritis relapsed after 4–6 weeks of drug withdrawal. The arthritis was fully resolved after 8 weeks of therapy with fluconazol injection at a dose of 400mg/d and douching articular cavity with amphotericin B once a week. And then sequential therapy with oral fluconazole was commenced. There was no any adverse effect occurrence during the course of treatment.

Discussion: Although Candida arthritis in patient with a hematological malignancy is rare, it still occurred in patient with hypoimmunity. Early diagnosis is difficult due to no distinctive clinical manifestation and hysteresis of pathogenic organism detection. It was found that the knee was the sole joint affected according to the review of fourteen other reports of Candida arthritis in patients with a hematological malignancy but the reason remains unclear. Fungal arthritis must be taken into consideration when dealing with patients with immune deficiency accompanied by arthritis, especially gonarthritis. We emphasize that the most important factors for the successful treatment of fungal arthritis are identified diagnosis and adequate dosage through out the course of treatment.