Recurrent arthritis caused by Candida parapsilosis
Candida arthritis is extremely rare and also represents a major challenge of diagnosis and treatment because the clinical manifestations, laboratory and radiologic findings are not specific and not well defined. Here is reported a rare case of recurrent arthritis caused by Candida parapsilosis.

A 56-year-old Chinese male suffered from recurrent pain and swelling in his right knee after several times of “small needle-knife” acupuncture and corticosteroid injection of the joint. Candida parapsilosis was cultured in his synovial fluid and identified by sequencing of its Internal Transcribed Spacer (ITS) gene. Here we present the radiological characteristics, arthroscopic pictures, and synovium pathology of this patient. Also, blood test and chemical analysis of his synovial fluid were listed as well as the ITS sequence of this Candida species identified. The patient underwent thorough arthroscopic debridement and then set on fluconazole 400 mg daily for 12 months. His symptoms resolved and no relapse was observed on the last follow-up. Additionally, a brief but comprehensive review of C. parapsilosis arthritis episodes from past to now were studied.

In the present study, the patient manifested with a mild chronic knee arthritis characterized by recurrent pain and swelling, leading to a diagnostic delay that lasted for almost one year. Fortunately, mycologic investigation was performed in his first visit to the hospital and C. parapsilosis was identified in the joint fluid and synovial tissue. C. parapsilosis is an opportunistic human pathogenic fungal species and also an uncommon cause of septic arthritis. For the patients with recurrent infection and underlying immunosuppression, clinicians should raise the suspicion of fungal infection. Moreover, many studies & reviews have showed that C. parapsilosis arthritis could occur in the knee (10/16), hip (2/16), shoulder (4/16) and wrist (1/16).

With the detailed clinical information reported in this case, researchers hope they would add to the knowledge of C. parapsilosis arthritis - its clinical settings, laboratory features, radiological characteristics, arthroscopic findings and experience of management.

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