Candida albicans arthritis in a nonimmuno-compromised patient: Complication of placebo intraarticular injections

Abstract

A nonimmunocompromised 32-year-old man with arthrosis of the knee participated as a placebo control in a clinical trial of intraarticular injections of hya-luronan. After the fourth weekly injection of saline, he developed a warm and swollen knee, and synovia! 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-fluo-rocytosine and surgical synovectomy. Quantitation of joint cartilage proteoglycan fragments in synovia! fluid indicated extensive breakdown of cartilage during the acute phase of arthritis but, parallel to clinical recovery, these levels returned to normal.