A Rare Case Of Candida Tenosynovitis Successful Suppressed With Voriconazole After Fluconazole Failure. Case Report And Review Of Literature

摘要

A 69-year-old patient presented with a Candida albicans bilateral tenosynovitis of the extensor digitorum muscles. Haematogenous spread was most likely as no trauma for direct inoculation was apparent, while he had been treated for Candida spondylodiscitis one year before. Although initial fungigram on the synovial fluid demonstrated susceptibility for fluconazole, therapy with fluconazole failed after in vivo resistance to fluconazole developed. Treatment with voriconazole was able to induce complete resolution of the tenosynovial inflammation without surgery. However, late recurrence occurred when voriconazole was stopped, possibly because of cross-resistance between fluconazole and voriconazole. Longterm oral therapy with voriconazole was able to supress the infection. Introduction To our knowledge, tenosynovitis caused by Candida infection has only been reported three times (Table I). The first reported case described a Candida tenosynovitis in a young boy with Buckley’s immunodeficiency in 1985.(1) He was treated with two surgical debridements after amphotericin B and 5-fluorouracil failed. The second case reported a 50-year-old man suffering a Candida tenosynovitis of the wrist after multiple corticoid infiltrations for median nerve entrapment.(2) He was treated with two synovectomies and oral fluconazole. The third patient involved a 36-year-old HIV positive women with a Candida tenosynovitis of the wrist without any other apparent risk factors.(3) Incision and drainage of the infected hand was performed and she was treated with oral fluconazole. Initially, there was a clinical improvement but recurrence of the swelling and pain occurred 16 days after surgery. A second debridement was required and she was maintained on oral fluconazole for one month. She had no recurrence of the Candida tenosynovitis, however, she died three months after the initial diagnosis due to a Pneumocystis jirovici pneumonia. The authors present a fort case of Candida tenosynovitis.